J Pak Med Assoc 2006 Apr; 56(4): 177-81 (Read article online)

Bokhari SA, Khan AA

Association of Oral and Systemic diseases has gained importance because the high occurrence of oral diseases is an extremely common source of infection. Epidemiological Studies have presented periodontal diseases as a risk factor for development of cardiovascular diseases. A chronic oral infection such as periodontitis is a constant potential source of infection and has now been considered as a separate risk factor for cardiovascular diseases, cerebrovascular diseases, peripheral arterial disease and respiratory diseases as well as delivery of low-birth-weight infants. The possible pathways linking oral infections to systemic diseases are metastatic infections, bacterial endotoxins, and systemic vascular injury. People with a history of periodontal disease and/or tooth loss were found at higher risk for Peripheral arterial disease (PAD) as compared to those without periodontal disease and/or tooth loss. All studies on the relationship of periodontal diseases to cardiovascular diseases are inconclusive and most of the data is based on epidemiological studies.

Arch Oral Biol 2006 May 16; (Read article online)

Xu Y, Wei W

OBJECTIVE: The purpose of this study was to compare the effectiveness of minocycline on treating experimentally induced periodontitis in rats when administered either as a systemic subantimicrobial dose or as a topical ointment. DESIGN: Thirty-two adult male Sprague-Dawley rats in four experimental groups-(1) model group; (2) systemic subantimicrobial dose of minocycline (5mg/kg/day) treatment group; (3) topical subgingival dose of minocycline (2mg/animal/week) treatment group; (4) control group. Experimentally induced periodontitis-silk ligatures were placed around the crevices of the second molar teeth and the animals fed a 10% sucrose drink. Assessment was carried out at days 28 and 56 using a number of different visual, histological and ultrastructure approaches. (1) Visual assessment-tooth mobility, gingival index and alveolar bone loss. (2) Histological examination-monocyte infiltration and resorption lacunae with osteoclasts. (3) Transmission electron microscopy (TEM)-morphological transformation of fibroblasts and osteoclasts. The collected data were analysed for statistical significance using the analysis of variance statistical test. RESULTS: Minocycline significantly reduced tooth mobility, gingival index and alveolar bone loss when administered either systemically or as a topical ointment compared to the model group (P<0.01). However, the alveolar bone loss was significantly less (P<0.01 in the systemic treatment group compared to the local treatment group. Monocyte infiltration and resorption lacunae with osteoclasts were significantly less in the both treatment groups compared to the model group (P<0.01). The osteoclasts failed to form a ruffled border in the systemic treatment group. CONCLUSION: Topical treatment significantly reduces gingivitis while systemic treatment is beneficial in terms of inhibiting alveolar bone loss.

Swed Dent J 2006; 30(1): 1-8 (Read article online)

Segerström S, Astbäck J, Ekstrand KD

The Composipost endodontic post, made of stretched aligned carbon fibers embedded in an epoxy-resin matrix, has since the beginning of the nineties been widely used for the restoration of endodontically treated teeth. The aim of this retrospective study was to evaluate the treatment outcome of the Composipost system up to 7 years. In a study published 1998, 236 patients treated during 1992-93 by seven Swedish general dental private practitioners were studied. Five of the former seven private practitionersi consented to participate in this follow up of that study. Thus the material was reduced to 138 patients. Thirty-nine of these were excluded due to insufficient data. For the remaining 99 patients, data were collected from dental records. All patients were offered a clinical examination but only 25 accepted. Data were collected from dental records for the remaining 74 patients. The mean follow up time was 6,7 years with a range from 1 month to 10 years (median 7.6 years, SD 2.5 years), (five teeth were extracted during the previous study). The outcome was considered successful if the post and core was in situ and showed no clinical or radiographic signs of technical failures. Sixty-four teeth (65%) restored with the Composipost system were successful after a mean time of 6.7 years. Thirty-two teeth were extracted due to fractures, periapical lesions and periodontitis. Dislodgment of post was observed in three cases. In conclusion, within the limitations of this study, after a mean time of 6.7 years, the Composipost restored teeth had shorter survival times than those of previously documented cast posts.

Anaerobe 2005 Dec; 11(6): 350-3 (Read article online)

Bhally HS, Lema C, Romagnoli M, Borek A, Wakefield T, Carroll KC

Leptotrichia buccalis is rarely implicated in systemic disease. We report two patients with clinically significant L. buccalis bacteremia which developed during the neutropenia secondary to chemotherapy. Based upon our experience, L. buccalis bacteremia should be considered in certain high-risk immunocompromised patients with mucositis and/or gingivitis.

Intern Med 2006 Aug; 45(8): 543-6 (Read article online)

Shibakuki R, Seto T, Uematsu K, Shimizu K, Seki N, Nakano M, Ishii H, Ohta M, Eguchi K

The patient was a 57-year-old man with a chief complaint of anterior chest pain who was diagnosed with clinical stage IV (c-T2N2M1) non-small-cell lung cancer (adenocarcinoma). Tenderness in the sternoclavicular joint, acne, periodontitis, and palmoplantar pustulosis were evident, and SAPHO syndrome was diagnosed. SAPHO syndrome is a rare disorder that results in synovitis, acne, pustulosis, hyperostosis, and osteomyelitis. Bone scintigraphy showed tracer accumulation in the costal cartilage, sternoclavicular joint, and cervical vertebrae 6-7. Although the bone lesions of SAPHO syndrome were difficult to differentiate from bone metastasis of pulmonary adenocarcinoma, metastatic bone tumors were ruled out by magnetic resonance imaging, computed tomography, and fluorodeoxyglucose positron emission tomography. There have been no previously reported cases of lung cancer with comorbid SAPHO syndrome. We report such a case and discuss the relevant literature, particularly that concerned with the evaluation of bone lesions.

Dent Update 2006 Apr; 33(3): 159-62 (Read article online)

Davies RM

Powered toothbrushes are a significant segment of the oral care market. Numerous clinical trials have compared the effectiveness of manual and powered toothbrushes for their effectiveness in improving oral health and the results are often conflicting. Recent Systematic Reviews by the Cochrane Oral Health Group have distilled this information and provided unbiased conclusions, namely that: powered toothbrushes with an oscillating rotating action are more effective than manual toothbrushes in reducing plaque and gingivitis; other types of powered toothbrushes produced less consistent reductions in plaque and gingivitis than manual brushes. Further studies are required to determine the relative effectiveness of manual and powered toothbrushes in improving the status of patients with periodontitis. CLINICAL RELEVANCE: This review provides the dental professional with an unbiased summary of current evidence regarding the relative effectiveness of manual and powered toothbrushes.

J Lipid Res 2006 May 15; (Read article online)

Rahman MM, Bhattacharya A, Fernandes G

Bone destruction is a pathological hallmark of several chronic inflammatory diseases, including rheumatoid arthritis, periodontitis, and osteoporosis. Inflammation-induced bone loss of this sort results from elevated numbers of bone-resorbing osteoclasts. Numerous studies have indicated that conjugated linoleic acid (CLA) positively influences on calcium and bone metabolism. Gene deletion studies have shown that receptor activator of NF-kappaB ligand (RANKL) is one of the critical mediators of osteoclastogenesis. In this report, we examined the ability of CLA to suppress RANKL signaling and osteoclastogenesis in RAW 264.7 cells, a murine monocytic cell line. Treatment of these cells with RANKL activated NF-kappaB, and preexposure of the cells to CLA significantly suppressed RANKL-induced NF-kappaB activation including phosphorylation of IkappaBalpha, degradation of IkappaBalpha and nuclear translocation of p65. RANKL induced osteoclastogenesis in these monocytic cells, and CLA inhibited RANKL-induced TNF-alpha production, and osteoclast differentiation including osteoclast-specific genes like tartrate resistant acid phosphatase (TRAP), cathepsin K, calcitonin receptor (CTR), matrix metalloproteinase (MMP)-9 expression and osteoclasts-specific transcription factors like c-Fos, nuclear factor of activated T-cells (NFATc1) expression, and bone resorptive pit formation. CLA also inhibited RANKL-induced activation of mitogen-activated protein kinase (MAPK), p38 but had little effect on c-Jun N-terminal kinase (JNK) activation. Collectively, these data demonstrate for the first time that CLA inhibits osteoclastogenesis by modulating RANKL signaling. Thus, CLA may have important therapeutic implications for the treatment of bone diseases associated with enhanced bone resorption by excessive osteoclastogenesis.

Hua Xi Kou Qiang Yi Xue Za Zhi 2006 Apr; 24(2): 106-9 (Read article online)

Zhang JJ, Chen YX, Xiao LW, Duan PJ, Zhao Q

OBJECTIVE: To study the integrin beta3 mRNA changes after orthodontic treatment on normal teeth and periodontitis teeth in rats. METHODS: 96 adult SD rats of 10 weeks old were randomly divided into normal tooth move-ment group and periodontitis tooth movement group. The rats in the two groups were sacrificed after 0 d, 12 h, 1 d, 3 d, 5 d and 7 d of tooth movement. The alveolar specimens were prepared. The integrin beta3 mRNA were detected using in situ hybridization in the specimens. The OD index of positively stained osteoclasts for integrin beta3 mRNA after orthodontic tooth movement in the two groups were measured and compared. RESULTS: There were weak positive signals on the cytoplasm of osteoclasts in periodontum in both groups after 12 hours and 3 days force activation. No positive signals were detected in the rest samples. There was no difference in the OD of positive stained osteoclasts between normal and periodontitis groups. Strong expressions were present on cells with one or two nuclei in the alveolar marrow. CONCLUSION: It is suggested that integrin beta3 mRNA is related with osteoclasts maturation and migration in orthodontic tooth movement.

Anaerobe 2006 Feb; 12(1): 52-7 (Read article online)

Urbán E, Radnai M, Novák T, Gorzó I, Pál A, Nagy E

The preterm delivery of low-birth-weight (PLBW) infants remains a significant public health issue and a leading cause of neonatal death and of long-term neurodevelopmental disturbances and health problems. Epidemiological and immunological studies have suggested that periodontal disease may be an independent risk factor for PLBW. The incidence of periodontal disease during pregnancy has been found to be associated with a significantly lower birth weight for gestational age after adjustment for race, parity and baby gender. The present case-control study, carried out to examine the distribution of anaerobes in pregnant women with periodontitis who experienced preterm delivery, provides microbial evidence that maternal periodontal disease and the presence of key pathogens are significant contributors to the obstetric risk of preterm delivery.

Clin Oral Investig 2006 May 16; (Read article online)

Kuru B, Yılmaz S, Argın K, Noyan U

This controlled clinical study investigated the clinical and radiographic outcome of wide intrabony periodontal defects treated by enamel matrix derivatives alone or in combination with a bioactive glass over a period of 8 months. Twenty-three chronic periodontitis patients, who received initial therapy and had radiographical interproximal defects with an associated probing depth of 6 mm or more and an intrabony component of at least 4 mm, were included. Each of the patients, contributing at least one intrabony defect, was treated with either enamel matrix derivative alone (group 1, n=10) or the combination (group 2, n=13). In both groups, all clinical and radiographical parameters were improved. Groups 1 and 2 presented a mean pocket reduction of 5.03+/-0.89 and 5.73+/-0.80 mm, recession of 0.97+/-0.24 and 0.56+/-0.18 mm, relative attachment gain of 4.06+/-1.06 and 5.17+/-0.85 mm, and radiographic bone gain of 2.15+/-0.42 and 2.76+/-0.69 mm, respectively. An intergroup comparison revealed significant differences for all of the parameters, yielding a more favorable outcome towards the combined approach. Within the limits of the study, both treatments resulted in marked clinical and radiographical improvements, but combined treatment seemed to enhance the results in the treatment of wide intrabony defects.

Spec Care Dentist 2006 Jan-Feb; 26(1): 13-9 (Read article online)

Morinushi T, Lopatin DE, Nakao R, Kinjyo S

The purpose of this study was to compare the onset and severity of gingivitis in children with Down syndrome, when compared to a healthy control group of children. The subjects included 41 children with Down syndrome ages two to 14 years (mean age: 7.6 years) and 112 age-matched healthy controls. We assessed the gingival health of all subjects using the gingival inflammation (M-PMA) index and periodontal probing depth (PD). Children were divided into three age categories: <5 years (AI), 5 to <10 years (AII), and 10 to <17 years (AIII). Supragingival plaque was measured using the Oral Hygiene Index (OHI) and the subjects were screened with the BANA test (Perioscan-Oral-B). Measurement of the M-PMA index in the healthy children showed an age-related increase (F = 10.369, p < 0.001), and the M-PMA index at the younger age group <5 year (AI) was significantly lower than that for the other two age groups All or AIII (p < 0.005, p < 0.001). In contrast, the M-PMA index values at AI and AIII in the subjects with Down syndrome were significantly higher than those for healthy children (p < 0.001, p < 0.001). Both groups had an age-related increase in PD (F = 3.388, p < 0.05 & F = 10.806, p < 0.001), and PD at AIII was significantly higher than that at AI in both groups (p < 0.01, p < 0.001). The children with Down syndrome showed an age-related increase in the BANA test score (F = 3.452, p < 0.05), and the BANA test score at AIII was significantly higher than that at AI (p < 0.02). The BANA test score in the healthy children was not age-related but was significantly higher than that in the children with Down syndrome (p < 0.02, p < 0.05).

Swed Dent J 2006; 30(1): 25-34 (Read article online)

Abrahamsson KH, Koch G, Norderyd O, Romao C, Wennström JL

The aim of this epidemiological survey was to analyze the periodontal conditions of 19-year old individuals in an urban area of Sweden, with special reference to gender and socioeconomic factors. A randomized sample of 272 individuals living in Göteborg, Sweden, was clinically examined with regard to oral hygiene, gingivitis, periodontal pockets, probing attachment loss (PAL) and gingival recession. Bitewing radiographs were used for assessments of alveolar bone level (ABL) and dental calculus. A questionnaire-based interview regarding oral hygiene habits was included. Data were analyzed with regard to differences between gender and socioeconomic grouping. The subjects showed a mean plaque score of 59% and a gingivitis score of 44%. 70% of the adolescents had a plaque score of > or = 50%, whereas corresponding figure for gingivitis was 37%. 27% of the subjects had at least one tooth with gingival recession. The mean prevalence of sites with probing depth of > or = 6 mm was 0.5, and the prevalence of PAL > or = 2 mm was 0.7. A radiographic bone level of > or = 2 mm was observed at on average 0.8 teeth per subject. Females had significantly less plaque and gingivitis than males and significantly higher number of teeth with gingival recession. There were no clinically significant differences in periodontal conditions between socioeconomic groups. In conclusion,the survey revealed higher prevalence of plaque and gingivitis among male than female adolescents but no differences between socioeconomic groups.

Br Dent J 2006 May 13; 200(9): 487-91 (Read article online)

White DA, Chadwick BL, Nuttall NM, Chestnutt IG, Steele JG

Background The 2003 Children's Dental Health Survey is the fourth in a series of decennial national children's dental health surveys.Aims This paper presents data on parental attitudes towards the care of children's teeth and gums, reported oral hygiene behaviours and clinical measures of hygiene and periodontal health in 2003 and highlights trends since previous surveys.Method A total of 10,381 children were examined in schools by trained and calibrated examiners. Four measures of hygiene and periodontal health were recorded as part of the clinical examination. In addition, 3,342 questionnaires were completed by parents of a sub-sample of these children. The questionnaire enabled information to be collected about reported oral health behaviours and parental attitudes.Results About three quarters of children across all age groups are reported to brush their teeth twice daily. A range of oral health products was reported as being used in addition to toothbrushes and toothpaste. There is a trend in parental preferences towards restoration of teeth rather than extractions and towards a better understanding of dental caries prevention. Although overall a higher proportion of children in this survey appeared to have gingival inflammation, plaque and calculus than 10 and 20 years ago, there was no change in the proportion of older children with gingivitis.Conclusions Dental practitioners have a role to play in reinforcing these positive attitudes and encouraging appropriate and effective oral hygiene behaviours in their child patients.

Swed Dent J 2006; 30(1): 17-23 (Read article online)

Jansson H, Lyssenko V, Gustavsson A, Hamberg K, Söderfeldt B, Groop L, Bratthall G

The aim of this study was to analyse whether the interleukin-1 (IL-1) and IL-6 gene polymorphisms were associated with the susceptibility of chronic periodontitis. Genomic DNA was obtained from 20 patients with chronic periodontitis and 31 periodontally healthy subjects. All subjects were of North European heritage. The test subjects were kept in a maintenance program after periodontal treatment but yet showing signs of recurrent disease. Genotyping of the IL-1alpha [+4845C>T], IL-1beta [-3954C>T] and IL-6 [-174G>C] polymorphisms was carried out using an allelic discrimination Assay-by-Design method on ABI PRISM 7900 Sequence Detection System. All genotypes were analyzed using the GeneMapper 2.0 software. A similar distribution of Single Nucleotide Polymorphism (SNP) was seen in both groups. Analysis by logistic regression including gender, IL-1alpha [+4845C>T], IL-1beta [-3954C>T], IL-6 [-174G>C] genotypes, the composite IL-1 genotype, the combination of the composite IL-1 genotype and the IL-6 -174G>C genotype and adjusting for smoking did not result in any statistically significant difference. SNPs in IL-1alpha [+4845C>T], IL-1beta [-3954C>T] and IL-6 [-174G>C] do not seem to increase the susceptibility to chronic periodontitis in this group of subjects.

Minerva Stomatol 2006 May; 55(5): 289-96 (Read article online)

Forabosco A, Spinato S, Grandi T, Prini M

conventional manual instrumentation with an ultrasonic technique (Odontoson M(R)) in scaling and root planing periodontal treatment. The effects of subgingival irrigation with 10% iodised solution in association with Odontoson M(R) were studied. METHODS: Sixty patients were selected: they were suffering from adult periodontitis, aged between 35 and 65 and non-smokers. They were randomly divided into 3 groups (Gs1, Gs2, Gs3). Gs1 was treated with curettage using Gracey curettes, Gs2 was treated with scaling and root planing using Odontoson M(R), while in Gs3 scaling and root planing with Odontoson M(R) irrigated with a 10% iodised solution were performed. Clinical parameters (probing depth, bleeding on probing, dental mobility, loss of attachment level) were measured before treatment (T0), after 30 days (T1), after 90 days (T2) and after 120 days (T3). RESULTS: No statistical significant differences between Gs1 and Gs2 were observed. The improvement of clinical parameters in Gs3 was greater and statistical significant differences with other groups treated were recorded. CONCLUSIONS: There are no significant differences between the effectiveness of scaling and root planing with manual instruments and with Odontoson M(R). The 10% iodised solution used such as topic antiseptic carries out greater effects in not surgical periodontal treatments.

J Can Dent Assoc 2006 May; 72(4): 323 (Read article online)

Cugini M, Warren PR

The design of the modern conventional manual toothbrush can be attributed to Dr. Robert Hutson, a Californian periodontist, who in the early 1950s developed the multitufted, flattrimmed, end-rounded nylon filament brush that became known as the Oral-B manual toothbrush. The trademark Oral-B emphasized that this was an oral brush, designed to clean all parts of the oral cavity, not merely a toothbrush. Flat-trimmed conventional toothbrushes based on the original Oral-B design have good plaque-removing capability when used carefully. However, limitations in terms of patients" brushing technique and brushing time necessitated a radical change in bristle pattern to improve performance, especially at approximal sites and along the gumline. Rationale for Product Development Detailed studies of the tooth-brushing process, using advanced scientific and ergonomic research methods, led to new toothbrush designs intended to maximize the efficacy of brushing efforts. These studies showed that the point of greatest interproximal penetration occurs when the direction of brushing changes; bristles angle back into the interproximal space, moving down and back up the adjoining approximal surface. These mechanics were further optimized on the basis of standardized evaluations of brush-design characteristics, including combinations of tuft lengths, insertion angles and tuft layout. With conventional vertical bristles these improvements yield limited benefits because only a few bristles are correctly positioned at the interproximal junction when the brush changes direction. Ultimately, a design with bristle tufts arranged at 16 masculine from vertical along the horizontal brush head axis was identified, in which the maximum number of bristles operated at the optimum angle throughout the brushing cycle. This design was significantly more effective (p < 0.001) than others in terms of penetration (by 9.6%) and cleaning effectiveness per brush stroke (by 15.5%). Effectiveness This discovery paved the way for a new toothbrush design with a unique patented array of tufts, which became known as the Oral-B CrossAction brush. This design was selected for extensive independent studies designed to evaluate plaque removal at the gingival margins and in the approximal areas and longer-term control of gingivitis, relative to current standard designs. In a series of studies (published in 2000), 14 single-brushing comparisons and 2 longer-term studies demonstrated the consistent superiority of the Oral-B CrossAction brush over the equivalent commercial standards. Since then, several additional studies have contributed further positive performance data for the CrossAction brush. Two of the studies demonstrated that plaque removal by this brush was superior to that of 15 other manual toothbrushes, and further investigations contributed similarly positive data. Longer-term data have confirmed superior CrossAction performance and the long-term benefits of improved efficacy, particularly for gingivitis. Discussion Novel approaches to toothbrush design have produced a toothbrush that, when tested in a large number of clinical studies, has consistently met or exceeded established standards of efficacy. The literature contains a wealth of performance data on various toothbrush designs, but none of these designs shows the year-on-year consistency and reproducibility of the Oral-B CrossAction.

J Antimicrob Chemother 2006 May 10; (Read article online)

Altman H, Steinberg D, Porat Y, Mor A, Fridman D, Friedman M, Bachrach G

Background: Antimicrobial peptides are components of the innate immunity that play an important role in systemic and oral health. OBJECTIVES: The antibacterial activity of the amphibian-derived K4-S4(1-15)a antimicrobial peptide was tested against oral pathogens associated with caries and periodontitis and compared with the activities of the human-derived antimicrobial peptides LL-37 and dhvar4a. METHODS: Growth inhibition of planktonic bacteria was tested using standard microdilution assays. Live/Dead staining followed by confocal scanning laser microscopy (CSLM) was used to determine the bactericidal effect of K4-S4(1-15)a on Streptococcus mutans attached to a glass surface or grown as biofilm. RESULTS: The cariogenic species S. mutans, Streptococcus sobrinus, Lactobacillus paracasei and Actinomyces viscosus were resistant to LL-37 found in the oral cavity. Porphyromonas gingivalis was the species most resistant to the three tested peptides. K4-S4(1-15)a demonstrated the highest activity against the tested planktonic bacteria. In addition, K4-S4(1-15)a was bactericidal to surface-attached S. mutans as well as to S. mutans biofilms grown in vitro. However, surface attachment increased S. mutans resistance to the antimicrobial peptide. CONCLUSIONS: Our results support growing evidence suggesting the use of antimicrobial peptides for prevention and treatment of oral disease.

Redox Rep 2006; 11(2): 71-7 (Read article online)

Komatsu T, Lee MC, Miyagi A, Shoji H, Yoshino F, Maehata Y, Maetani T, Kawamura Y, Ikeda M, Kubota E

Oral manifestations of Down syndrome include high susceptibility to gingival inflammation with early onset and rapidly progressive periodontitis. The influence of reactive oxygen species (ROS) on periodontitis of Down syndrome is unclear. The aim of this study was to characterize ROS formation in Down syndrome-gingival fibroblasts (DS-GF) using electron spin resonance (ESR) spin trapping with 5,5-dimetyl-1-pyrolline-N-oxide (DMPO), and to determine whether ROS generation plays a role in the pathogenesis of periodontitis in Down syndrome patients. We observed formation of the DMPO-OH spin adduct, indicating HO(*) generation from cultured DS-GF and non-DS-GF. The increased HO(*) generation in cultured DS-GF was strongly decreased in the presence of the H(2)O(2) scavenger, catalase, or the iron chelator, desferal. This may due to the enzymatic ability of over-expressed CuZn-superoxide dismutase in Down syndrome to catalyze the formation of H(2)O(2) from O(2)(*-), thereby increasing the availability of substrate H(2)O(2) for the irondependent generation of HO(*) via the Fenton reaction, suggesting that HO(*) generated from DS-GF may be involved in progressive periodontitis of Down syndrome.

Gen Dent 2006 Mar-Apr; 54(2): 123-4 (Read article online)

Brooks JK, Tiwary R

An extreme example of pathologic tooth migration associated with bruxism and severe periodontitis is presented. The prognosis of the tooth was deemed hopeless; it subsequently was extracted. Various etiological factors of abnormal tooth displacement are discussed.

Spec Care Dentist 2006 Mar-Apr; 26(2): 66-70 (Read article online)

Suresh L, Martinez Calixto LE, Radfar L

Mucous membrane pemphigoid (MMP) is a heterogeneous group of autoimmune, chronic inflammatory ubepithelial vesiculobullous disorders, predominantly affects the mucous membranes of the oral cavity and eyes of the elderly population. Oral manifestations of pemphigoid include desquamative gingivitis, ulcers, erythematous patches, erosions, vesicles and bullae located on the attached gingiva, palate, buccal mucosa, labial mucosa, and tongue. Diagnosis is based on history, clinical features and a biopsy stained with hematoxylin and eosin (H&E), and also direct and indirect immunofluorescence. Topical and systemic corticosteroids are the most commonly used medications for managing pemphigoid. Recently, topical tacrolimus has been successfully used in the treatment of ocular and skin pemphigoid. In this report we present a patient with longterm recalcitrant MMP that did not respond to conventional treatment but as treated successfully with tacrolimus ointment.