Page 55 - MDJ Volume 47 Number 2 ( Jul-Dec 2024)

Abstracts

1 Department of Periodontics, Dental Specialist Centre Seremban, Seremban, bacterial infection, characterized by the formation of a
2
Negeri Sembilan, Malaysia, Department of Dental Public Health, Dental cutaneous necrotic ulceration or black eschar, surrounded
Specialist Centre Seremban, Seremban, Negeri Sembilan, Malaysia, by an erythematous halo. EG lesions are a result of
3 Department of Stomatology Unit, Institute of Medical Research, Health Institute,
Shah Alam Selangor, Malaysia perivascular bacterial invasion in the cutaneous tissues,
leading to necrotizing vasculitis. It is uncommon in healthy
Introduction: Localised gingival overgrowths are common in individuals, with only six percent of lesions affecting
clinical practice and pose diagnostic challenges due to their the facial region. Case Report: A febrile 10-month-old
varied aetiologies, influenced by local or systemic factors. Malay girl presented with facial swelling originating
While clinical appearance may hint at the lesion’s nature, it from an insect bite on her left upper lip. Within a day, the
is not always reliable. This case series highlights the need for solitary red swelling at the bite site had evolved into an
thorough evaluation and histopathological investigation eschar-covered ulcer, before progressing rapidly to facial
of gingival lesions, regardless of their clinical presentation. cellulitis. Examination revealed a black eschar encrusted
Case Report: Case 1: A 43-year-old Chinese female with over a necrotic skin ulcer on the vermillion border of
generalised periodontitis stage III grade C presented with her left upper lip, surrounded by erythema and swelling
a non-tender gingival overgrowth that increased in size extending to the left maxilla. Her past medical history
for the past three months in the region of teeth 14-17 that was non-contributory. The patient’s febrile condition,
causing chewing difficulties. The lesion sized 60x30mm, full blood count and elevated C-Reactive Protein results
pedunculated, oedematous-fibrotic and multinodular suggested an infectious etiology rather than an allergic
extending to the occlusal plane covering the crown of reaction to the insect bite. A cutaneous swab for culture
tooth 15. Non-surgical periodontal therapy (NSPT) was and sensitivity revealed Pseudomonas aeruginosa,
performed before an excisional biopsy, which revealed a confirming the diagnosis of Ecthyma gangrenosum. A
pyogenic granuloma. Fifteen months postoperatively, the combination of anti-pseudomonal beta-lactam (Tazocin)
site remained healthy with no recurrence. The patient was and an aminoglycoside (Amikacin) was implemented.
placed under supportive periodontal care for ongoing Despite intravenous antibiotic therapy, she showed slow
monitoring. Case 2: A 63-year-old Malay female with improvement in healing. Debridement of the necrotic
generalised periodontitis stage IV grade C presented ulcer was performed with chlorhexidine daily, and healing
with a firm, oval-shaped, sessile gingival overgrowth by secondary intention was closely monitored. Minimal
measuring 15x10mm in the labial region of teeth 22-23. scabbing was observed on the vermillion border two
The lesion matched the surrounding tissue colour and was months later during follow-up. Conclusion: Pseudomonas
asymptomatic. After NSPT, a biopsy procedure raised a aeruginosa infections are difficult to eradicate due to the
full-thickness flap, revealing bone exostoses. The enlarged organism’s capability of delaying wound healing and
soft tissue and underlying bone were excised and sent for developing drug-resistance. Cutaneous manifestations of
histopathological examination (HPE). The HPE indicated EG may result from primary inoculation or hematogenous
that if the lesion was extraosseous, it was a peripheral dissemination in bacteremic patients. This case report
odontogenic fibroma; if intraosseous, it suggested highlights the importance of recognizing the distinct
sclerosing odontogenic carcinoma or odontogenic features of pseudomonas infection. An early diagnosis
fibroma. The patient was referred to an oral surgeon for facilitates the initiation of appropriate antibiotics and
close monitoring and further management. Twelve months effective wound management, crucial for enhancing
postoperatively, the site remained healthy with no signs patient outcomes.
of recurrence. Conclusion: These contrasting outcomes
highlight that localised gingival overgrowths, even those Keywords: Anti-pseudomonal antibiotic, ecthyma gangrenosum,
appearing benign, should not be underestimated. Early and facial, Pseudomonas aeruginosa infection, skin lesion
accurate diagnosis is essential for appropriate management
and can significantly impact patient outcomes.
P022
Keywords: Gingival disease, gingival enlargement, gingival
overgrowth Oral Midazolam Sedation Efficacy in Paediatric Dental
Patients with 8-6-4-2 Fasting or Light Meal Fasting
Protocol
P021
Wan Aeisyah Binti Wan Ahmed , S. Norsamsu Arni , M. Zuliani ,
1
1
1
Black Eschar on the Upper Lip: A Clue to the Diagnosis W. A. Wan Muhamad Amir , H. Ruhaya , I. Suki 2
1
1
of Pseudomonas aeruginosa Infection 1 Department of Pediatric Dentistry, School of Dental Sciences, University Sains
Malaysia, Kubang Kerian, Kelantan, Malaysia, Department of Anaesthesiology
2
Nor Hafizah Ain Binti Mohd Zakaria, Y. P. Chan and Intensive Care, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan,
Department of Pediatric Dentistry, Kuala Lipis Hospital, Kuala Lipis, Malaysia Malaysia
Background: Ecthyma gangrenosum (EG) is Introduction: Fasting protocol is one of the important
pathognomonic of underlying Pseudomonas aeruginosa checklists prior to sedation, however, the pre-operative
Malaysian Dental Journal ¦ Volume 47 ¦ Issue 2 ¦ July-December 2024 49