case_images: PMC11835479_01
case_images: Scab-like patches were noted on the left side of the scalp.
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case_images: fig1
case_images: Scab-like patches were noted on the left side of the scalp (Figure 1), while no bullae lesions were evident on the visible body parts.
case_images: (a) Intraoral photographs show desquamative, whitish, scrapable patches noted on the marginal and attached gingivae extending from 45 to 47 buccally. (b) Isolated, shallow, erythematous raw ulcers were observed on the right hard palate (measuring 2.5 x 2.5 cm). (c) Multiple, shallow, erythematous raw ulcers are present on the lower left lingual. (d) Multiple firm, painless, pale-pink nodular enlargements observed in the interdental papilla extend to the facial and palatal gingival margins in the maxilla. It is delineated by a groove of tissue that does not bleed on touch. (e) Red/bluish-red gingival enlargements (secondary inflammation) were noted at the interdental papilla of the mandibular anterior regions and (f) between Teeth 33 and 34.
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case_images: fig2
case_images: Periodontal health assessment revealed generalized oedematous, erythematous marginal gingiva and interdental papillae, with desquamative gingivitis, whitish scrapable patches on the marginal and attached gingivae extending from 45 to 47 buccally and generalized on the lingual aspect on the lower arch (Figure 2(a)). Isolated, shallow, erythematous raw ulcers were observed on the right side of the hard palate, measuring 2.5 x 2.5 cm (Figure 2(b)). Multiple shallow erythematous raw ulcers were also observed on the lower left lingual region (Figure 2(c)). The enlargements generally appear more inflamed and exhibit a minimal fibrotic component, more evident in the first and second sextants (Figure 2(d)) than in the rest, which seem to have a smoother texture and are reddish or bluish-red (Figure 2(f)).
case_images: Periodontal health reassessment. Source: Department of Periodontology, University of Bern. "Periodontal Chart Online." Last modified 2010 (http://www.periodontalchart-online.com).
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case_images: fig3
case_images: The full-mouth plaque score was 93%, indicating poor oral hygiene (Figure 3).
case_images: The OPG revealed predominantly horizontal bone loss, ranging from 20% to 30% across most sites. More advanced horizontal bone loss of up to 50% was observed on the distal aspect of Tooth 37, which has a history of surgical removal of an adjacent tooth (MOS). There was also evidence of widening of the periodontal ligament (PDL) space associated with Teeth 36 and 37. Additionally, aberrant root morphology was noted on Tooth 47.
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case_images: fig4
case_images: Additionally, an orthopantomogram (OPG) was taken to evaluate bone levels and detect any underlying alveolar bone loss or other abnormalities, which confirmed generalized moderate horizontal bone loss consistent with the clinical diagnosis of generalized periodontitis (Figure 4).
case_images: (a, b) Ulcerative lesions present on bilateral buccal mucosa along the level of the occlusal plane and right retromolar pad region.
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case_images: fig5
case_images: However, the patient experienced a flare-up of PV in November 2023, resulting in severe pain with a VAS of 8/10 and bilateral ulceration on buccal mucosa at the level of the occlusal plane and right retromolar pad region (Figures 5(a) and 5(b)).
case_images: Intraoral clinical photographs depicting the periodontal status after 16 months of discontinuing tab. cyclosporin.
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case_images: fig6
case_images: At the recent visit in April 2024, the patient reported feeling satisfied with minimal pain (VAS 0-1), and no new oral lesions were observed (Figure 6).
case_images: Periodontal health reassessment. Source: Department of Periodontology, University of Bern. "Periodontal Chart Online." Last modified 2010 (http://www.periodontalchart-online.com).
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case_images: fig7
case_images: BOP had decreased to 31%, and the full-mouth plaque score had improved to 31% (Figure 7).
case_images: Intraoral photograph demonstrating a reduction in the size of the lesions with partial resolution of the surrounding erythema and inflammation.
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case_images: fig8
case_images: The remaining gingivae were less erythematous and edematous, with complete resolution of gingival enlargements compared to the baseline records (Figure 8).