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Tan JY, Teo GN, Ng E, Tay ABG, Tay JRH. Gingival Necrosis Related to Sepsis-Induced Agranulocytosis Due to Pseudomonas aeruginosa Bacteraemia: A Case Report. J Clin Med 2024; 13:1285. [PMID: 38592105 PMCID: PMC10931707 DOI: 10.3390/jcm13051285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
Background: There have been no reports of sepsis-induced agranulocytosis causing gingival necrosis in otherwise medically healthy patients to the authors' best knowledge. Even though there are several case reports of gingival necrosis secondary to medication-induced agranulocytosis, they have not systematically described the natural progression of agranulocytosis-related gingival necrosis. Methods: This paper presents a case report of a 29-year-old female Indian patient with generalised gingival necrosis and constitutive signs of intermittent fever, nausea, and vomiting. She also complained of abdominal pains. Blood counts showed agranulocytosis, and the patient was admitted for a workup of the underlying cause. Parenteral broad-spectrum antibiotics were administered, which brought about clinical resolution. Results: Her gingival necrosis was attributed to sepsis-induced agranulocytosis triggered by Pseudomonas aeruginosa bacteraemia, and upon clinical recovery, spontaneous exfoliation left behind exposed bone. Secondary healing over the exposed alveolar bone was noted after a year-long follow-up, albeit with some residual gingival recession. Conclusions: Oral manifestations of gingival necrosis, when present with concomitant constitutive symptoms, could indicate a serious underlying systemic condition that could be potentially life-threatening if left untreated. Dentists should be cognizant of this possibility so that timely intervention is not delayed.
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Affiliation(s)
| | - Guo Nian Teo
- Department of Oral and Maxillofacial Surgery, National Dental Centre, Singapore 168938, Singapore; (G.N.T.); (A.B.G.T.)
| | - Ethan Ng
- Department of Restorative Dentistry, National Dental Centre, Singapore 168938, Singapore;
| | - Andrew Ban Guan Tay
- Department of Oral and Maxillofacial Surgery, National Dental Centre, Singapore 168938, Singapore; (G.N.T.); (A.B.G.T.)
| | - John Rong Hao Tay
- Department of Restorative Dentistry, National Dental Centre, Singapore 168938, Singapore;
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Guan P, Wong SF, Lim JQ, Ng CCY, Soong PL, Sim CQX, Ong CK, Rajasegaran V, Myint SS, Lee JY, Tan HK, Iyer NG, Soo KC, Teh BT, Tay ABG. Mutational Signatures in Mandibular Ameloblastoma Correlate with Smoking. J Dent Res 2019; 98:652-658. [PMID: 30917298 DOI: 10.1177/0022034519837248] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Ameloblastoma is a rare tumor of odontogenic epithelium, the low incidence rate of which precludes statistical determination of its molecular characterizations. Despite recent genomic and transcriptomic profiling, the etiology of ameloblastomas remains poorly understood. Risk factors of ameloblastoma development are also largely unknown. Whole exome sequencing was performed on 11 mandibular ameloblastoma samples. We identified 2 convergent mutational signatures in ameloblastoma: 1) a signature found in multiple types of lung cancers with probable etiology of tobacco carcinogens (COSMIC signature 4) and 2) a signature present in gingivobuccal oral squamous cell carcinoma and correlated with tobacco-chewing habits (COSMIC signature 29). These mutational signatures highlight tobacco usage or related mutagens as one possible risk factor of ameloblastoma, since the association of BRAF mutations and smoking was demonstrated in multiple studies. In addition to BRAF hotspot mutations (V600E), we observed clear inter- and intratumor heterogeneities. Interestingly, prior to BRAF mutation, important genes regulating odontogenesis mutated (e.g., corepressor BCOR), possibly playing important roles in tumorigenesis. Furthermore, recurrent mutations in the CDC73 gene, the germline mutations of which predispose patients to the development of jaw tumors, were found in 2 patients, which may lead to recurrence if not targeted by therapeutic drugs. Our unbiased profiling of coding regions of ameloblastoma genomes provides insights to the possible etiology of mandibular ameloblastoma and highlights potential disease risk factors for screening and prevention, especially for Asian patients. Because of the limited sample size and incomplete habitual, dietary, and occupational data, a causal link between tobacco usage and ameloblastoma still requires further investigations.
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Affiliation(s)
- P Guan
- 1 Integrated Biostatistics and Bioinformatics Programme, Duke-NUS Medical School, Singapore.,2 Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore.,3 Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - S F Wong
- 2 Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - J Q Lim
- 2 Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore.,4 Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore
| | - C C Y Ng
- 2 Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - P L Soong
- 5 Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore
| | - C Q X Sim
- 5 Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore
| | - C K Ong
- 4 Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore
| | - V Rajasegaran
- 2 Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - S S Myint
- 2 Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - J Y Lee
- 2 Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - H K Tan
- 6 Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - N G Iyer
- 6 Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - K C Soo
- 6 Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - B T Teh
- 2 Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore.,7 Cancer Science Institute of Singapore, National University of Singapore, Singapore.,8 Institute of Molecular and Cell Biology, Singapore.,9 Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore.,10 SingHealth/Duke-NUS Institute of Precision Medicine, National Heart Centre Singapore, Singapore
| | - A B G Tay
- 5 Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore
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Sun SY, Yeo WC, Tay ABG, Tan DTH, Tan DBP. Canine and Premolar Root Dimensions in Chinese. A Reference for Osteoodontokeratoprosthesis Surgery. Asia Pac J Ophthalmol (Phila) 2018; 7:76-83. [PMID: 29508951 DOI: 10.22608/apo.2017515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Osteoodontokeratoprosthesis (OOKP) surgery is used to restore vision in end-stage corneal disorders, where an autogenous tooth supporting an optical cylinder is implanted through the cornea under a buccal mucosal graft. The ideal tooth for OOKP is a healthy single-rooted permanent tooth with sufficient buccolingual/palatal root diameter to accommodate an optical cylinder. The aim of this study was to determine the buccolingual/palatal diameters of canine and premolar roots in Chinese, for selection of teeth for OOKP surgery. DESIGN This was an anatomical study on root dimensions of extracted intact teeth. METHODS Extracted canine and premolar teeth (excluding maxillary first premolars) were collected and the buccolingual/palatal and mesiodistal diameters of the root at the cervical line and at 2-mm intervals below the cervical line were measured with Vernier calipers. Other measurements included total tooth length, crown buccolingual/palatal diameter, and root length. Mean and minimum buccolingual/palatal root diameters were compiled for each 2-mm interval. RESULTS A total of 415 extracted teeth (198 male, 217 female) were collected and measured. Recorded dimensions of keratoprostheses in 55 previous OOKP surgeries were used to establish acceptable lamina dimensions to ascertain root size adequacy. Premolars in Chinese female patients were undersized in a small minority. Minimal dimensions of teeth were insufficient if at 6 mm root level, the buccolingual/palatal width was less than 5 mm, or the mesiodistal width was less than 3 mm. This was noted in female mandibular first premolars (5.6%), maxillary second premolars (4.5%), and mandibular second premolars (1.5%). CONCLUSIONS Canines have adequate dimensions for OOKP surgery. However, premolars in Chinese females may be undersized in a small minority.
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Affiliation(s)
- Stella Yue Sun
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore
| | - Woon Chee Yeo
- Department of Orthodontics, National Dental Centre Singapore, Singapore
| | - Andrew Ban Guan Tay
- Department of Oral & Maxillofacial Surgery, National Dental Centre Singapore, Singapore
| | | | - Danny Ben Poon Tan
- Department of Oral & Maxillofacial Surgery, National Dental Centre Singapore, Singapore
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Tay ABG, Lai JB, Lye KW, Wong WY, Nadkarni NV, Li W, Bautista D. Inferior Alveolar Nerve Injury in Trauma-Induced Mandible Fractures. J Oral Maxillofac Surg 2015; 73:1328-40. [DOI: 10.1016/j.joms.2015.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/04/2015] [Accepted: 02/04/2015] [Indexed: 10/23/2022]
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Tay ABG, Zuniga JR. Clinical characteristics of trigeminal nerve injury referrals to a university centre. Int J Oral Maxillofac Surg 2007; 36:922-7. [PMID: 17875382 DOI: 10.1016/j.ijom.2007.03.012] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 03/14/2007] [Accepted: 03/20/2007] [Indexed: 12/21/2022]
Abstract
The aim of this retrospective study was to determine the aetiology and characteristics of trigeminal nerve injuries referred to a university centre with nerve injury care. Fifty-nine patients with 73 injured trigeminal nerves were referred in 10 months. The most common aetiologies were odontectomy (third molar surgery) (52.1% of nerves), local anaesthetic (LA) injections (12.3%), orthognathic surgery (12.3%) and implant surgery (11.0%). The inferior alveolar nerve (IAN) was most commonly injured nerve (64.4%), followed by the lingual nerve (LN) (28.8%). About a quarter of IAN injuries (27.3%) and half of LN injuries (57.1%) from odontectomy had severe sensory impairment. There were twice as many LN than IAN injuries from local anaesthetic injections, but all had mild or no sensory impairment. Nerve injuries from implant surgery occurred only in IAN injuries; none had severe sensory impairment. Neuropathic pain occurred in 14.9% of IAN injuries and only in those with mild or no sensory impairment. Nerve surgery was offered to 45.8% of patients; a third underwent surgery.
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Affiliation(s)
- A B G Tay
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina at Chapel Hill, CB #7450, Chapel Hill, NC 27599-7450, USA.
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Tay ABG, Tan DTH, Lye KW, Theng J, Parthasarathy A, Por YM. Osteo-odonto-keratoprosthesis surgery: a combined ocular–oral procedure for ocular blindness. Int J Oral Maxillofac Surg 2007; 36:807-13. [PMID: 17630251 DOI: 10.1016/j.ijom.2007.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 03/22/2007] [Accepted: 04/23/2007] [Indexed: 10/23/2022]
Abstract
The aim of this retrospective study was to describe the oral procedures used in osteo-odonto-keratoprosthesis (OOKP) surgery, and the demographics and oral findings of candidate patients in Singapore. The OOKP procedure utilizes an autologous tooth-bone complex to mount a poly-methylmethacrylate optical cylinder, as an artificial cornea, stabilized by an overlying autologous buccal mucosal graft. Consecutive patients referred over 3 years for dental evaluation prior to OOKP surgery were included. A total of 21 patients underwent oral clinical and radiographic evaluation. The aetiology of blindness included Stevens-Johnson's syndrome (11 cases), chemical burns (9 cases) and multiple failed corneal grafts (1 case). Evaluation revealed that 12 patients were suitable for OOKP surgery, 8 were at risk of complication or failure and 1 had no usable teeth. Fourteen patients have undergone unilateral OOKP Stage 1 surgery successfully. Complications included fracture of a tooth from its lingual bone necessitating the harvesting of a second tooth (1 case), oronasal perforation (1 case), exposure of adjacent roots (5 teeth), lower lip paresthesia (2 cases) and submucosal scar band formation in the buccal mucosal graft donor site (10 cases). Thirteen patients have completed Stage 2 surgery, with attainment of their best possible visual potential following OOKP surgery.
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Affiliation(s)
- A B G Tay
- Department of Oral & Maxillofacial Surgery, National Dental Centre, 5 Second Hospital Avenue, Singapore 168938, Singapore.
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Abstract
PURPOSE In this prospective study, we sought to determine the incidence of inferior alveolar nerve (IAN) paresthesia in patients with an exposed IAN bundle seen intraoperatively. PATIENTS AND METHODS We included consecutive patients undergoing third molar surgery in whom an exposed IAN bundle was seen in the third molar socket intraoperatively. Data recorded from patients included radiographic findings, variations in surgical method, intraoperative findings, complications, and postoperative sequelae. Patients were reviewed 1 week after surgery and evaluated subjectively and objectively to determine the incidence of paresthesia when the IAN bundle was exposed. Patients with paresthesia were followed for 2 years or until it resolved. RESULTS An exposed IAN bundle was seen in 192 operation sites in 170 patients over a 5-year period, of which 166 patients with 187 operation sites were included in this study. Thirty-eight operation sites (20.3%) showed paresthesia at 1 week after surgery (95% confidence interval, 14.5% to 26.1%); 20 sites (15.0%) showed abnormal objective assessment results. By 3 months from surgery, 57.9% of nerves had recovered to normal sensation, 65.8% of nerves recovered by 6 months, and 71.1% of nerves recovered by 1 year. Eight patients were lost to follow-up. Logistic regression showed that the operator, male gender, older age, and root curvature were significant risk factors for paresthesia. CONCLUSIONS Sighting an exposed intact IAN bundle during third molar surgery indicates its intimate relationship with the third molar and carries a 20% risk of paresthesia, with a 70% chance of recovery by 1 year from surgery.
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Affiliation(s)
- Andrew Ban Guan Tay
- Department of Oral and Maxillofacial Surgery, National Dental Centre, Singapore.
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