title: Sarcoidosis affecting the periodontium: a long-term follow-up case.
abstract: BACKGROUND
  Clinical manifestations of sarcoidosis affecting the periodontium could mimic aggressive periodontitis. This case report documents the occurrence of sarcoidosis affecting the periodontium, including its clinical features, diagnosis, treatment, and 6-year follow-up.
  
  
  METHODS
  An individual with a history of pulmonary sarcoidosis was referred for evaluation and treatment of an aggressive periodontal condition. Clinical, radiographic, and histopathologic findings supported the diagnosis of sarcoidosis affecting the periodontium. Initial treatment consisted of reinforcement of oral hygiene, scaling and root planing, chlorhexidine rinses, and periodontal maintenance. The systemic disease was managed with prednisone, alendronate, and losartan. Twelve months later, the patient returned with severe attachment loss of sudden onset and gingival recession affecting the facial right surfaces of maxillary posterior teeth. In addition, he complained of chronic pain of moderate to severe intensity involving both jaws. The affected teeth were extracted and the surrounding alveolar bone was debrided. Intraoral sarcoidosis was confirmed by histologic findings, and his medications were changed to methotrexate and hydroxychloroquine.
  
  
  RESULTS
  The patient has been followed for 6 years with continuation of the systemic medications and periodontal maintenance every 3 to 4 months without recurrence of intraoral sarcoidosis.
  
  
  CONCLUSIONS
  The main features of this unique periodontal presentation were pain, rapidly progressive gingival recession, and significant changes in alveolar bone density in focal areas. Careful review of medical history and close monitoring of intraoral conditions are critical for patients with a history of sarcoidosis. An intraoral biopsy is necessary to confirm a definitive diagnosis in cases with similar clinical findings.
authors.affiliation: Department of Periodontics, The University of Texas Dental Branch at Houston, Houston, TX, USA.
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Moretti
authors.forename: Maria F
authors.initials: MF
authors.lastname: Fiocchi
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Flaitz
mesh_terms: D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D002180:Candidiasis, Oral / Q000188:drug therapy; D005500:Follow-Up Studies; D005889:Gingival Recession / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D008439:Maxillary Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D010510:Periodontal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D011859:Radiography; D012507:Sarcoidosis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology