Category Archives: Periodontics and oral medicine

Primary Tuberculous Lymphadenitis: a Rare Case Report

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Mustafa Mert Açikgöz, Ayşem Yurtseven, Gülsüm Ak
İstanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Turkey


Background/Aim: Our aim is to describe multidisciplinary approach to primary tuberculous lymphadenitis with a case report.

Case Report: A 6-year-old boy was referred to İstanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery with the symptoms of painless extra-oral abscess and lymphadenopathy. The diagnosis of primary tuberculous lymphadenitis was proved by microbiological culture and ultrasound imaging.

Conclusions: Combine tuberculosis treatment should be applied and long term follow up is necessary. Excisional biopsy for tissue diagnosis and bacterial examination with culture should be performed for an early diagnosis as a delay in treatment can lead to devastating consequences.

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Presence of Different Candida Species at Denture Wearers With Type 2 Diabetes and Clinically Healthy Oral Mucosa-Pilot Study

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Sanja Matić Petrović1, Milena Barać1, Jovana Kuzmanović Pfićer1, Milena Radunović1, Aleksandra Jotić2, Ana Pucar1

1School of Dental Medicine, University of Belgrade, Belgrade, Serbia
2Faculty of Medicine University of Belgrade, Belgrade, Serbia


Background/Aim: The aim of this study was to examine prevalence of different Candida spp. at diabetics and nondiabetics wearing dentures without clinical signs of Denture Stomatitis (DS) and to study if some local and systematic factors are confounders for harboring Candida at these subjects. Material and Methods: Total of 60 subjects wearing partial or complete upper acrylic denture having at least half of palatal mucosa covered by denture were selected and stratified into three experimental groups: systematically health subjects; patients with diagnosed Type 2 Diabetes (T2D) and good glycoregulation; and T2D subjects with poorly regulated blood sugar level. Cotton swab samples were obtained from each patient from hard palate mucosa and denture surface. Swab cultures were made on Sabouraud dextrose agar and ChromAgar Media for distinciton of various Candida spp. Density growth was also measured. Results: Frequency of Candida spp. findings were similar between groups. At healthy subjects, only C.albicans was detected. At diabetics, C.albicans was the most common isolated species, followed by C.glabrata and C.tropicalis. Negative finding of yeasts on palatal mucosa, but positive on denture surface were detected at all groups, with the highest frequency (33.4%) at diabetics with poor glycoregulation. Denture surface was heavier colonized than hard palate mucosa. Duration of diabetes in years were only independent predictors for harboring Candida spp. at denture surface (Exp B=1.186, CI=1.047-1.344, p=0.007). Conclusions: Prosthesis of denture wearers without DS may serve as reservoir of Candida spp. Presence of more pathogenic and resistant non-albicans species are related to diabetics, even without clinical signs of DS.

Keywords: Stomatitis; Denture; Candida albicans; Diabetes Mellitus Type 2; Denture; Complete; Denture; Partial; Removable


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Citation Information: Balkan Journal of Dental Medicine, Volume 22, Issue 1, Pages 15–21, ISSN (Online) 2335-0245,DOI:

Oral Alterations in Diabetes Mellitus

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Smiljka Cicmil1, Irena Mladenović1, Jelena Krunić2, Dragan Ivanović3, Nikola Stojanović2

1 Department of Oral Rehabilitation, Faculty of Medicine, University of East Sarajevo, Foča, Bosnia and Herzegovina
2 Department of Dental Pathology, Faculty of Medicine, University of East Sarajevo, Foča, Bosnia and Herzegovina
3 3Department of Preventive Dentistry, Faculty of Medicine, University of East Sarajevo, Foča, Bosnia and Herzegovina



Diabetes mellitus is one of the most common chronic diseases which continue to increase in number and significance. It presents the third most prevalent condition among medically compromised patients referring for dental treatment. Diabetes mellitus has been defined as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Hyperglycemia leads to widespread multisystem damage which has an effect on oral tissue. The present article summarizes current knowledge regarding the association between diabetes mellitus and oral and dental health.

Keywords: Diabetes Mellitus; Oral Disease; Oral Health



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Balkan Journal of Dental Medicine, Volume 22, Issue 1, Pages 7–14, ISSN (Online) 2335-0245,DOI:

Gingival Crevicular Fluid Levels of Prolidase and Alkaline Phosphatase in Periodontitis

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Berrak Guven1 / Cigdem Turervir2

1Department of Biochemistry, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
2Department of Periodontology, Faculty of Dentistry, Bulent Ecevit University, Zonguldak, Turkey


Background/Aim: The purpose of this study was to investigate gingival crevicular fluid (GCF) alkaline phosphatase (ALP) and prolidase levels in subjects with different periodontal status. Material and Methods: Fifteen periodontitis, fifteen gingivitis and fifteen healthy subject were included. GCF samples were collected from participants. Probing depth, clinical attachment level, gingival index was recorded. ALP and prolidase levels were determined in GCF by spectrophotometrically. Results: Higher values of ALP were found in periodontitis compared with gingivitis and healthy control (p<0.001). The values of prolidase were lower in periodontitis than healthy control (p<0.05). A statistically significant positive correlation was found between clinical parameters and ALP levels (p<0.001). There is no significant correlation between clinical parameters and prolidase levels (p>0.05). Additionally, no significant correlation was detected between ALP and prolidase (r= -0.309, p>0.05). Conclusion: Our preliminary data suggest that low prolidase level in periodontitis was not associated with ALP and clinical parameters, which represent periodontal destruction and inflammation.

Keywords: Prolidase; ALP; Periodontitis; Gingivitis


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Citation Information:Balkan Journal of Dental Medicine, ISSN (Online) 2335-0245, DOI: Citation


Aetiology, Diagnosis and Treatment of Ankyloglossia

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Christina Charisi / Anna Koutrouli / Athina Moschou / Aristidis Arhakis

School of Dentistry, Aristotle University of Thessaloniki, Greece


This review paper occupies with the frequency, etiology, diagnosis, treatment and the possible complications of Ankyloglossia (AG). AG is a congenital anomaly and its range varies from 0,1% to 4,8 %. There are several methods for the diagnosis of AG. The most popular method is the ‘’Hazelbaker’’, which assesses seven different tongue movements and five appearance characteristics. As far as the management of AG is concerned, there are two options, the ‘’wait-and-see’’ and the invasive procedure. The operator can choose between the frenotomy and the frenectomy. The difference is that in frenectomy the clinician removes the whole frenulum. Few complications have been mentioned, such as ulcers, pain, bleeding and noticeable scar, which were brought on to a second operation.

Keywords: Ankyloglossia; Breast Feeding; Frenectomy


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Citation Information:Balkan Journal of Dental Medicine, ISSN (Online) 2335-0245, DOI: Citation

Intraoral Myeloid Sarcoma with Bilateral Involvement – Case Report

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Athanasios Poulopoulos1 / Fotios Iordanidis2 / Dimitrios Andreadis1 / Konstantinos Antoniadis3

1Department of Oral Medicine & Oral Pathology, Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece
2Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Cheltenham, United Kingdom of Great Britain and Northern Ireland
3Department of Oral & Maxillofacial Surgery Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece


Background: Myeloid sarcoma (MS) is a solid malignant tumour associated with infiltration of immature myeloid precursor cells in an extramedullary site. The term MS has replaced the term granulocytic sarcoma and chloroma, which were used in the past. MS in the oral cavity is very uncommon, with less of 40 cases reported until recently. Case Report: We report the first case, the features, and the diagnostic sequence, of intraoral MS with bilateral palatal involvement, which presented as an initial manifestation, and preceded the appearance of acute myeloid leukaemia (AML). Diagnostic confirmation of such oral mucosal lesions usually requires biopsy, histopathological examination with additional immunohistochemical investigation. MS can occur during the course of acute or chronic myelogenous leukaemia, and myelodysplastic syndromes. In the vast majority of the reported cases, only one site was involved with a single intraoral MS lesion, and the cases predominantly associated with AML. Conclusion: The majority of intraoral MS occurs in patients with known AML, but in some of them, presented as an initial manifestation, and preceded the appearance of the disease. Therefore, clinicians should carefully evaluate all unusual oral lesions of unknown origin.

Keywords: Myeloid sarcoma; Granulocytic sarcoma; Chloroma; Acute myeloid leukaemia; Oral tumours


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Citation Information: Balkan Journal of Dental Medicine, ISSN (Online) 2335-0245, DOI: Export Citation

Oral Granular Cell Tumor: Report of Case Series and a Brief Review of the Literature

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Panayiotis Karakostas / Apostolos Matiakis / Eleftherios Anagnostou / Alexandros Kolokotronis

Department of Oral Medicine and Pathology, School of Dentistry of Aristotle, University of Thessaloniki, Thessaloniki, Greece


.Background/Aim: The present analysis focuses on examining a case series of eight patients diagnosed with a granular cell tumor located in the oral cavity. Case series: The patients’ clinical states were thoroughly studied, along with the histopathological and immunohistochemical examinations findings. Their surgical treatment and postoperative course are also within the scope of this analysis. Numerous histogenesis theories and the appropriate tumor treatment are mentioned within the article being always in accordance with the relative literature. Conclusions: Oral granular cell tumor is a benign oral disease of possible neural origin commonly located on the tongue. Surgical excision is the treatment of choice. In any case, histological and immunohistochemical examination confirm both the clinical diagnosis and the differential diagnosis between oral squamous cell carcinoma.

Keywords: Neurological Origin Oral Tumor; Oral Granular Cell Tumor; Tongue Soft Tumor


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Citation Information: Balkan Journal of Dental Medicine, ISSN (Online) 2335-0245, DOI: Export Citation

Molecular Profiling of Odontogenic Tumors – Pilot Study

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Sibel Elif Gültekin1 / Burcu Sengüven1 / Reem Aziz2 / Carina Heydt2 / Reinhard Buettner2

1Gazi University Faculty of Dentistry, Department of Oral Pathology, Ankara, Turkey
2University of Cologne, Faculty of Medicine, Department of Pathology, Cologne, Germany


Background/Aim: In the pathogenesis of odontogenic tumors which arise from the rests of the dental apparatus in the jaw, several molecular pathways have been shown to play critical roles such as genetic alterations in the hedgehog, BRAF/Ras/MAPK, epidermal growth factor receptor. Next generation genomic sequencing has identified gene mutations in many different tumors. Materials and Methods: Here we report four types of odontogenic tumor including six cases in which five had mutation according to next generation sequencing analysis from archival paraffin blocks that diagnosed previously as ameloblastoma (solid), amloblastoma (unicystic-mural), ameloblastic fibroma, squamous odontogenic tumor, and adenomatoid odontogenic tumor. Results: All ameloblastomatic tumors were shown BRAF mutation and adenomatoid odontogenic tumors were KRAS mutation. Conclusion: This evidence may highlight the poorly understood pathogenesis of odontogenic tumors. Further comparisons need to be made with other benign and malignant odontogenic tumors so that unique odontogenic features may be found.

Keywords: Odontogenic Tumors; Next Generation Sequencing; Mutation


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Citation Information: Balkan Journal of Dental Medicine, ISSN (Online) 2335-0245, DOI: Export Citation

Oral Symptoms and Mucosal Lesions in Patients with Diabetes Mellitus Type 2

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1 / Olivera Govedarica1 / Jelena Lečić1 / Snežana Mališ3 / Smiljka Cicmil1 / Saša Čakić2

1Faculty of Medicine, University of East Sarajevo, Foca, Bosnia and Herzegovina
2Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
3University Hospital, Foca, Bosnia and Herzegovina


Background: Good glycoregulation at patients with diabetes mellitus is essential for prevention of many complications, including those in oral cavity. Results of numerous studies indicate that xerostomia and neurosensory oral disorders are present in type 2 diabetics. A review of the literature shows contradictory results about prevalence of oral mucosal lesions in diabetics. The aim of this study was to evaluate the presence of xerostomia, neurosensory disorders and mucosal lesions in oral cavity of type 2 diabetics.

Material and Methods: This study involved 90 adults, 60 with type 2 diabetes and 30 healthy subjects, aged 45-65 years. With regard to value of HbA1c level diabetics were divided into two groups: 30 subjects with satisfactory glycoregulation (HbA1c<9%) and 30 subjects with poor glycoregulation (HbA1c≥9%). All patients recruited into the study completed a questionnaire that included their demographic, medical and oral health data. Clinical examination of the oral mucosa was performed by a single examiner.

Results: In relation to the presence of xerostomia and dysgeusia between satisfactory controlled diabetics and healthy subjects a significant difference was observed (p<0.05). Compared with healthy subjects, poor controlled diabetics had significantly higher presence of xerostomia (p<0.001) and neurosensory disoders (p<0.05). A higher prevalence of oral mucosal lesions was found in poor controlled diabetics, but significant difference between groups was not observed (p>0.05). A significant positive correlation was revealed between smoking and glossodynia as well as smoking and glossopyrosis (p>0.05).

Conclusion: Glycemic control level seems to influence the susceptibility of type 2 diabetics to xerostomia and neurosensory disorders. Less clear is whether diabetes are corellated to oral mucosal lesions.

Keywords: Diabetes Mellitus; Xerostomia; Glossodynia; Dysgeusia; Oral Mucosa


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Citation Information: Balkan Journal of Dental Medicine. Volume 21, Issue 1, Pages 50–54, ISSN (Online) 2335-0245, DOI:, March 2017

The Influence of Crown Ferrule on Fracture Resistance of Endodontically Treated Maxillary Central Incisors

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13 / Julie Popovski1 / Alesh Dakskobler2 / Ljubo Marion3 / Peter Jevnikar3

1Department of Prosthodontics, Faculty of Dental Medicine, University of Ss. Cyril and Methodius, Skopje, Macedonia (the former Yugoslav Republic of)
2Ceramics Engineering Department, Institute Joseph Stefan (IJS) Ljubljana, Slovenia
3Department of Prosthodontics, Faculty of Medicine (MF), University of Ljubljana, Slovenia


Background: Prefabricated zirconia posts can contribute to increasing the fracture resistance of the endodontically treated teeth. Purpose. This in vitro study compared the fracture resistance of endodontically treated central maxillary incisors prepared with 2 mm ferrule length to the ones without ferrule.

Material and methods: Twenty-four caries-free maxillary central incisors were divided into 2 groups of 12. In group A circumferential external dentin shoulders were prepared for 2 mm external dentin ferrule length. There was no ferrule preparation in Group B. Zirconia VALLPOST BO-S (Ø 1,6 mm), Ljubljana, Slovenia were used with retention forms in the coronary part. Core build-up was made of pressed ceramics (IPS e.max Press, Ivoclar, Liechtenstein). Crowns were manufactured from the same ceramic material (IPS e.max Press, Ivoclar). After root canal treatment and post space preparation, all posts were cemented with an adhesive resin cement (Multilink Automix, Ivoclar). The specimens were embedded in acrylic resin blocks (ProBase Polymer/Monomer, Ivoclar) and loaded at an angle of 45° to the long axis in an Instron Testing Machine 4301 (Instron Corp., USA) at a crosshead speed of 1 mm/min until fracture. Fracture patterns and loads were recorded. A significance level of p<0.05 was used for all comparisons. Two-way analysis of variance was used for statistical analysis. Failure patterns were analyzed with the optical microscope Stereo Discovery V.8 (Carl Zeiss, Germany) and compared using the chi-square nonparametric test.

Results: The mean values (±SD) of fracture loads (N) for the Groups A and B were 664.63N (±49.14) and 519.36N (±71.65) recpectively. Significantly lower failure loads were recorded for the specimens in the group B. Failure patterns within the groups revealed non-catastrophic failure in 70% of the specimens for group A and 85% for group B.

Conclusions: Within the limitations of this in vitro study, it can be concluded that zirconia VALLPOST BO-S (Ø 1,6 mm) with press-ceramic cores and crowns, can be used for restoration of endodontically treated teeth. The teeth prepared with 2 mm external dentin ferrule length were found to be more fracture resistant than teeth without ferrule.

Keywords: Endodontically Treated Teeth; Zirconia Post; Press Core; Press Crown; Ferrule


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Citation Information: Balkan Journal of Dental Medicine. Volume 21, Issue 1, Pages 44–49, ISSN (Online) 2335-0245, DOI:, March 2017