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Anadolu Kliniği Tıp Bilimleri Dergisi, Eylül 2022; Cilt 27, Sayı 3
Idiopathic red lesion: case series
İdiopatik kırmızı lezyon: olgu serisi
Kubra Ceran Deveci,
Yasin Cicek,
Abdulsamet Tanik
Department of Periodontology,
Faculty of Dentistry, Adıyaman
University
Abstract
The first step in the treatment of periodontal diseases is to mechanically remove plaque
and dental calculus, which play a role in the etiology of periodontal diseases, and to es-
tablish oral hygiene. In some cases of oral diseases, some drugs and chemical agents can
be used for various reasons in addition to mechanical treatment. Corticosteroids are fre-
quently used in oral mucocutaneous diseases because of their strong anti-inflammatory,
antiallergic and immunosuppressive eects in the treatment of many other diseases.
Although there are dierent ways of using corticosteroids, the topical form is often pre-
ferred in the treatment of oral lesions associated with oral mucosal diseases. This case
series aims to evaluate the eect of topical corticosteroid application on red lesions in
the gingiva that do not heal with conventional periodontal treatment.
Keywords: gingivitis; idiopathic; corticosteroid
Öz
Perodontal hastalıkların tedavsnde lk basamak, perodontal hastalıkların etyolojsnde
rol oynayan bakter plağı ve dştaşlarının mekank olarak uzaklaştırılması ve oral hjyenn
sağlanmasıdır. Bazı oral hastalık durumlarında mekank tedavye ek olarak, çeştl sebep-
lerle bazı laç ve kmyasal ajanlar kullanılablmektedr. Kortkostreodler; brçok hastalığın
tedavsnde güçlü antnflamatuar, antalerjk ve mmünosupresf etkler nedenyle oral
mukokütonoz hastalıklarda sıklıkla kullanılmaktadır. Kortkosterodlern farklı kullanım
şekller olsa da oral mukozal hastalıklarla lşkl ağız lezyonlarının tedavsnde sıklıkla
topkal formu terch edlmektedr. Bu olgu sersnn amacı, konvansyonel perodontal
tedavy takben yleşmeyen dşetndek kırmızı lezyonlara topkal kortkosterod uygula-
masının etksn değerlendrmektr.
Anahtar Sözcükler: gngvts; dyopatk; kortkosterod
Anadolu Klin / Anatol Clin
Gelş/Received :
04.01.2022
Kabul/Accepted:
15.06.2022
DOI: 10.21673/anadoluklin.1053380
Yazışma yazarı/Corresponding author
Kübra Ceran Devec
Adıyaman Unversty, Faculty of Dentstry,
Department of Perodontology, Adıyaman,
Türkye
E-mal: k_crn@hotmal.com
ORCID
Kübra Ceran Devec: 0000 0002 5962 7495
Yasn Ççek: 0000 0002 8207 8148
Abdulsamet Tank: 0000-0002-4430-2196
Case report / Vaka sunumu
342
Anatolian Clinic Journal of Medical Sciences, September 2022; Volume 27, Issue 3
INTRODUCTION
Oral mucosa is a region that has its specic lesions
and many systemic diseases lesions can be seen in the
oral mucosa (1). Lesions occurring in the oral mucosa
are classied in many ways according to their color,
localization, etiology, and morphological features and
are classied as white, red, and pigmented lesions ac-
cording to their color (2,3). e red colorization of the
lesions may be due to thin epithelial structure, inam-
mation, dilatation or increased number of blood ves-
sels, and extravasation of blood into the oral so tis-
sues (4). It is usually seen on the lips, buccal mucosa,
oor of the mouth, tongue, palate, and gingiva. Etiol-
ogy may be trauma, infection, immunological causes,
or idiopathic (1).
Corticosteroids are used in the treatment of many
diseases due to their strong anti-inammatory, anti-
allergic and immunosuppressive eects. ey can be
used in dierent ways such as topical, oral/systemic,
inhalation, nasal and intra-articular (5). Systemic
steroids are preferred for multiple and widespread le-
sions in the acute period, as long-term use can cause
serious side eects. Topical steroids (TS) can be ap-
plied in many forms such as cream, gel, and lotion
in the basic treatment of many oral mucosal diseases
such as lichen planus, recurrent aphthous stomatitis,
pemphigus vulgaris, erythema multiforme, gra-
versus-host disease (6). TS are preferred in long-term
treatments because of their advantages such as strong
anti-inammatory and immunosuppressive eects,
low side eects when used properly, and minimal sys-
temic absorption (7).
In cases with gingival tissue involvement rst and
basic stages of periodontal treatment are the me-
chanical removal of bacterial plaque and dental cal-
culus that plays a role in the etiology of periodontal
diseases, and the establishment of oral hygiene. Local
or systemic antimicrobial agents, antibiotics, and cor-
ticosteroids can be used to support periodontal treat-
ment if the targeted improvement cannot be achieved.
is case series aim to evaluate the eect of topical
corticosteroids isolated by the physician on the red le-
sions of the gingiva that do not heal with periodontal
treatment.
CASE 1
A 24-year-old female patient was admitted to the peri-
odontology clinic with complaints of gingival bleeding
and bad breath. Her medical history showed no sys-
temic disease. Findings of clinical examination were
intense plaque accumulation due to poor oral hygiene,
gingival edema, hyperemia, and bleeding with a mild
intervention by a periodontal probe. In addition, lo-
calized red lesions were observed in the free and at-
tached gingiva, unlike erythema due to plaque accu-
mulation (Figure 1A). e mean plaque index before
treatment was 2.5 and the gingival index was 2.2. Ini-
tial treatment was administered to the patient, oral hy-
giene training was given and she was called for control
at regular intervals. Although some gingival improve-
ment was achieved aer the initial treatment, hyper-
emia continued. Gingival hyperemia was inconsistent
with the amount of plaque and calculus. e patient
was followed up at regular intervals for three months.
Topical corticosteroid (Kenacort–A Orabase, Deva,
İstanbul) was applied by the physician once a day for
5 days to the persistent lesions that did not respond to
conventional periodontal treatment aer three months
(Figure 1B). e area was isolated with cotton rolls,
so tongue and mouth movements and saliva did not
reduce the eectiveness of the drug (Figure 1C). e
agent applied to the cotton swab was le on the lesion
for 60 seconds and the patient was advised not to take
any food or liquid for 30 minutes aer the application.
e patient was called for monthly follow-up examina-
tions. At the end of the treatment process, it was ob-
served that there were signicant improvements in the
lesions (Figure 1D).
CASE 2
A 14-year-old female patient applied to our clinic
with the referral of another physician. Her medical
history showed no systemic disease. In the clinical ex-
amination; oral hygiene was adequate and the mean
plaque index before treatment was 0.5 and the gingival
index was 0.2. Linear erythema was observed in the
maxilla anterior vestibule region (Figure 2A). Initial
periodontal treatment was applied to the patient. De-
spite conventional treatments, improvement in red le-
Idiopathic lesion
Deveci et al.
343
Anadolu Kliniği Tıp Bilimleri Dergisi, Eylül 2022; Cilt 27, Sayı 3
Anadolu Klin / Anatol Clin
sions could not be achieved. Aer three months from
conventional treatment, topical corticosteroid (Kena-
cort–A Orabase, Deva, İstanbul) application was per-
formed with the procedure described above, and the
lesions completely healed (Figure 2B).
CASE 3
A 29-year-old female patient was admitted to our clinic
with the complaint of gingival redness that persists for 3
years. e patient stated that she had been treated many
times during this time and used many drugs, but her
gums did not heal. Clinical examination of the systemi-
cally healthy patient showed erythema in the free and
attached gingiva in the anterior vestibule region of the
mandibula (Figure 3A). Plaque and calculus were mini-
mal, and the mean plaque index before treatment was
0.6 and the gingival index was 0.4. e patient received
non-surgical periodontal treatment and oral hygiene
training. e patient was called for follow-up at regu-
lar intervals. Aer three months, topical corticosteroid
(Kenacort–A Orabase, Deva, İstanbul) treatment was
applied to persistent red lesions with the same proce-
dure. At the end of the healing process, the complete
disappearance of lesions was observed (Figure 3B).
CASE 4
A 48-year-old female patient was admitted to our clinic
with the complaint of bleeding in her gingiva. She had
no systemic diseases and she had been using a xed
prosthesis for 5 years in her dental anamnesis. In the
clinical and radiographic examination ndings were
gingival redness and edema, increase in pocket depth,
and clinical attachment loss, and the patient was diag-
nosed with periodontitis (Figure 4A). e erythema
seen in the anterior region of the maxilla was localized
in the free and attached gingiva and was redder than
the alveolar mucosa. e patient was given initial peri-
odontal treatment and oral hygiene training was given.
en, a ap operation was performed on the area to
eliminate pathological pockets. Topical corticosteroids
(Kenacort–A Orabase, Deva, İstanbul) were applied
with the same procedure to persistent red lesions that
did not heal aer six months from the operation (Figure
4B). Adequate recovery was achieved at the end of the
treatment process and xed prosthetic restoration was
performed (Figure 4C). No recurrence was observed in
the 5-year follow-up (Figure 4D).
Nikolsky sign was negative in all cases and no mu-
cocutaneous lesion was observed.
Figure 1A Figure 1B Figure 1C
Figure 1D Figure 2A Figure 2B
344
Anatolian Clinic Journal of Medical Sciences, September 2022; Volume 27, Issue 3
Report ethics
Written informed consent was obtained from the pa-
tients for the publication of these case reports and the
accompanying images.
DISCUSSION AND CONCLUSION
Periodontal diseases are chronic infectious diseases that
cause inammation in dental support tissues. e pri-
mary etiological factor is pathogenic bacteria and their
products in microbial dental plaque. Many genetic, en-
vironmental, and systemic factors that drive the host
response also inuence disease onset, progression, and
severity (8). e currently accepted treatment method
for periodontal diseases is traditional periodontal treat-
ments that include oral hygiene education, tooth sur-
face cleaning, and root surface straightening. In cases
where the eect of non-surgical periodontal treatment
is little or insucient, some drugs can be used to sup-
port non-surgical periodontal treatment (9).
Topical corticosteroids are classied according to
their eectiveness as mild, moderate, potent, and very
potent. Triamcinolone acetonide, which is in the mod-
erate group, is a frequently preferred agent because of
its orabase form that adheres to the oral mucosa, its
eectiveness, and ease of use (10).
ongprasom et al. in their study, applied 0.1%
topical triamcinolone acetonide to 7 of 13 patients
diagnosed with lichen planus, and 0.1% topical cy-
closporine treatment to 6 of them 3 times a day. Aer
2 weeks, 33.5% improvement was observed in the le-
sions of the patients treated with cyclosporine, while
the lesions of the patients treated with triamcinolone
acetonide were improved by 50% (11).
In another study by Voute et al. the ecacy of topi-
cal corticosteroid use with the help of adhesive tape
was evaluated in 20 patients diagnosed with oral li-
chen planus (12). In the follow-up of the patients for
3-17 months; it was reported that 20% had a complete
and 60% a good-partial response to treatment while in
the placebo group no complete response was obtained
in any of the patients and the responses were evaluated
as good-partial remained 30%.
Topical corticosteroids are among the drugs pre-
ferred in the treatment of recurrent aphthous stoma-
titis (13). A double-blind, placebo-controlled study
evaluated the ecacy of topical corticosteroids in the
treatment of recurrent aphthous stomatitis. It was re-
ported that the duration of aphthae was shortened and
the symptoms were reduced in the topical corticoste-
roid group compared to the placebo group (14).
In a case report, topical corticosteroids were used
Idiopathic lesion
Deveci et al.
Figure 3A
Figure 4B
Figure 3B
Figure 4C
Figure 4A
Figure 4D
345
Anadolu Kliniği Tıp Bilimleri Dergisi, Eylül 2022; Cilt 27, Sayı 3
in the treatment of rare plasma cell mucositis and im-
provement was reported in resistant oral lesions (15).
Although topical corticosteroids are frequently
used in the treatment of many oral mucosal diseases
in the literature, usage patterns and doses vary. e
oral mucosa is a moist environment due to saliva and
it is constantly exposed to mouth and tongue move-
ments; this may result in reduced eectiveness of the
local agents. Examination of studies that evaluate the
ecacy of TS in the treatment of oral mucosal diseases
showed that TSs were generally administered by the
patient. In our study, the area to be treated with TS was
isolated and the agent was applied by the physician at
regular intervals, preventing the decrease in the eec-
tiveness of the drug in the mouth.
Non-surgical periodontal treatment was applied to
three of the cases and periodontal surgical treatment
was applied to one, and it was observed that the red
lesions did not show sucient healing at the end of the
process. Signicant improvement was observed in red
lesions following topical corticosteroid application. In
resistant oral lesions, in addition to periodontal treat-
ment and improvement of oral hygiene, topical cor-
ticosteroid application is benecial for controlling le-
sions and regaining oral health.
Topical corticosteroids provide successful clinical
results in the treatment of various diseases aecting
the oral mucosa when applied correctly by the phy-
sician, not by the patients. erefore, dentists should
know the indications, side eects, and clinical appli-
cation methods of topical steroids in order to apply
an eective treatment in oral mucosal diseases and to
protect patients from possible side eects.
Conflict-of-interest and nancial disclosure
e authors declare that they have no conict of inter-
est to disclose. e authors also declare that they did
not receive any nancial support for the study.
REFERENCES
1. Karapınar G. Ünür M. Drugs used in the treatment of
oral mucosal diseases Yeditepe Dent J .2019;15(3):336-
73.
2. Tekin M, Çam OH. Oral mukoza hastalıkları ve semp-
tomatolojisi. Klinik Gelişim Dergisi. 2012;25:93-8.
3. Cicek Y, Ertaş U. e normal and pathological pigmen-
tation of oral mucous membrane: a review. J Contemp
Dent Pract.2003:4(3):76-86.
4. Epstein JB, Gordon S. Managing patients with red or
red-white oral lesions. J Can Dent Assoc. 2013;79:d95.
5. Vijayavel T, Praveena NM, Ramani P.Corticosteroids
in oral diseases. Indian Journal of Drugs and Diseases.
2012;1:168-70.
6. ongprasom K,Dhanuthai K. Steriods in the treatment
of lichen planus: a review. J Oral Sci. 2008;50(4):377-85.
7. Ramadas AA, Jose R, Arathy SL, Kurup S, Chandy ML,
Kumar SP. Systemic absorption of 0.1% triamcinolone
acetonide as topical application in management of oral
lichen planus. Indian J Dent Res. 2016;27(3):230-5.
8. Kinane DF, Peterson M, Stathopoulou PG. Environmen-
tal and other modifying factors of the periodontal dis-
eases. Periodontol 2000. 2006;40(1):107-19.
9. Drisko CH. Nonsurgial periodontal therapy. Periodontol
2000. 2001;25(1):77-88.
10. Carbone M, Goss E, Carrozzo M, et al. Systemic and
topical corticosteroid treatment of oral lichen planus:
a comparative study with long-term follow-up. J Oral
Pathol Med. 2003;32(6):323-9.
11. ongprasom K, Chaimusig M, Korkij W, Sererat T,
Luangjarmekorn L, Rojwattanasirivej S. A randomized-
controlled trial to compare topical cyclosporin with tri-
amcinolone acetonide for the treatment of oral lichen
planus. J Oral Pathol Med. 2007;36(3):142-6.
12. Voute AB, Schulten EA, Langendijk PN, Kostense PJ,
van der Waal I. Fluocinonide in an adhesive base for
treatment of oral lichen planus: a double-blind, place-
bo-controlled clinical study. Oral Surg Oral Med Oral
Pathol. 1993;75(2):181-5.
13. Siegel MA. Strategies for management of commonly en-
countered oral mucosal disorders. J Calif Dent Assoc.
1999;27(3):210–2.
14. ompson AC, Nolan A, Lamey J. Minor aphthous
oral ulceration: a double-blind cross-over study of be-
clomethasone dipropionate aerosol spray. Scott Med J.
1989; 34(5):531-2.
15. Wongtim, K. Subbalekha K, Chaisuparat R, ongpra-
som K. Plasma cell mucositis: an unusual case.Ameri-
can Journal of Oral Medicine.2018:4(2):18-23.
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