{"title":"Scapulothoracic Dissociation Following a Fall From Standing Height: A Rare and Atypical Presentation of Severe Shoulder Girdle Injury.","authors":"Dimitrios Giotis, Christos Konstantinidis, Christos Koukos, Dimitrios Vardakas, Sotiris Plakoutsis","doi":"10.7759/cureus.80652","DOIUrl":"https://doi.org/10.7759/cureus.80652","url":null,"abstract":"<p><p>Scapulothoracic dissociation (SD) is a rare and severe injury, typically associated with high-energy trauma. It is characterized by scapular displacement, often leading to neurovascular compromise. SD resulting from low-energy mechanisms, such as a fall from standing height, is exceptionally rare. We present the case of a 93-year-old male who sustained SD after a fall from standing height. He was hemodynamically unstable upon arrival, with progressive neurological deficits in the right upper limb. Computed tomography (CT) revealed an isolated right scapular glenoid fracture with lateral scapular displacement and a large hematoma, while CT angiography ruled out major vascular injury. Conservative management included hemodynamic stabilization and immobilization with a Velpeau-type splint. One month post-injury, neurological function in the affected upper extremity had significantly improved. By five months, the patient had regained nearly full, painless shoulder range of motion without neurological deficits. Although SD is classically associated with high-energy trauma, this case highlights its occurrence following minor trauma in elderly patients. Clinicians should maintain a high index of suspicion for SD in atypical presentations to facilitate early diagnosis and optimize treatment.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80652"},"PeriodicalIF":1.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-03-16eCollection Date: 2025-03-01DOI: 10.7759/cureus.80681
Hideki Mori, Kenichirou Suzuki, Masako Kawamura, Takashi Yao
{"title":"Epithelial-Stromal Polyp With Features of Perineurioma Lacking Covering Serrated Crypts Associated With a Sessile Serrated Lesion With High-Grade Dysplasia of the Colon: A Case Report.","authors":"Hideki Mori, Kenichirou Suzuki, Masako Kawamura, Takashi Yao","doi":"10.7759/cureus.80681","DOIUrl":"https://doi.org/10.7759/cureus.80681","url":null,"abstract":"<p><p>A 79-year-old woman received a colonoscopy, and 6 polyps were found in the proximal colon. Histologically, four polyps were conventional tubular adenomas. Interestingly, one protuberant polyp was a sessile serrated lesion (SSL) with high-grade dysplasia being regarded as a potent precursor lesion for colorectal cancers. The polyp was connected with a flat-type SSL. Furthermore, another polyp was a bland spindle cell lesion filling the lamina propria. The polyp lacked covering serrated epithelium. Although the mesenchymal neoplasm displayed architectural features of perineurioma, immunoexpression of epithelial membrane antigen (EMA) and GLUT1 was negative. Accordingly, the benign mesenchymal neoplasm was considered an unusual epithelial-stromal polyp with a perineurioma-like lesion. In cases of usual perineuriomas, stromal cell proliferation is suggested to be a concern for serrated crypts that often harbor BRAF mutation. However, the mechanical nature of the proliferation of stromal cells in the polyps without serrated crypts is unknown. For the present case, proliferation of the mesenchymal cells of the epithelial-stromal polyp was suspected to relate to the serrated lesion near the polyp. Moreover, it is also presumed that the occurrence of the six polyps, including the serrated lesion, mesenchymal neoplasm, and tubular adenomas in the proximal colon, took part in both the BRAF and WNT signal pathways.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80681"},"PeriodicalIF":1.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-03-15eCollection Date: 2025-03-01DOI: 10.7759/cureus.80636
Pratiksha Patel, Bhavin Patel, Shruti D Vyas, Maitri S Patel, Tanvi Hirani, Mainul Haque, Santosh Kumar
{"title":"A Narrative Review of Periodontal Vaccines: Hope or Hype?","authors":"Pratiksha Patel, Bhavin Patel, Shruti D Vyas, Maitri S Patel, Tanvi Hirani, Mainul Haque, Santosh Kumar","doi":"10.7759/cureus.80636","DOIUrl":"https://doi.org/10.7759/cureus.80636","url":null,"abstract":"<p><p>Globally, periodontal diseases, mainly driven by polymicrobial biofilms, are a widespread concern of social medicine due to their considerable incidence and tie-up to systemic disorders like diabetes, cardiovascular diseases, and complications during pregnancy. Traditional treatments focus on mechanical debridement and antimicrobial therapies, but these approaches have limitations, including recurrence and antibiotic resistance. Periodontal vaccines offer a promising alternative by targeting the immunological mechanisms underlying periodontal disease. This review explores the current state of periodontal vaccine development, highlighting key antigens, vaccine delivery systems, and preclinical and clinical advancements. Special emphasis is placed on antigen selection, host variability, immune tolerance, and future directions to overcome these barriers. This article highlights the advancements and challenges in periodontal vaccine research, offering insights into the capability of immunoprophylaxis as a groundbreaking way to manage periodontal diseases.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80636"},"PeriodicalIF":1.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-03-15eCollection Date: 2025-03-01DOI: 10.7759/cureus.80622
Jose L Mejia, Luis Mejia Sierra
{"title":"Recurrent Idiopathic Thrombocytopenic Purpura Associated With Splenosis: A Case Report.","authors":"Jose L Mejia, Luis Mejia Sierra","doi":"10.7759/cureus.80622","DOIUrl":"https://doi.org/10.7759/cureus.80622","url":null,"abstract":"<p><p>Immune thrombocytopenic purpura is a bleeding disorder in which the immune system develops antibodies against its cells, such as platelets, causing purpura and hemorrhagic episodes. The problem can be primary or idiopathic and secondary to other conditions, such as certain drugs and autoimmune conditions like lupus erythematosus. In children, spontaneous remissions are not uncommon, but they are rare in adults, in whom, after a period of medical treatment, splenectomy is necessary. Recurrence after surgery requires extensive workup, and although not quite common, remnants of the spleen or splenules should be suspected as one of the causes. The present case report relates to a recurrent disease episode several years after surgery, its management, and evolution after reoperation.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80622"},"PeriodicalIF":1.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-03-15eCollection Date: 2025-03-01DOI: 10.7759/cureus.80599
Bruno Bordoni, Allan R Escher
{"title":"Muscles and Central Neural Networks Involved in Breathing: State of the Art.","authors":"Bruno Bordoni, Allan R Escher","doi":"10.7759/cureus.80599","DOIUrl":"https://doi.org/10.7759/cureus.80599","url":null,"abstract":"<p><p>Breathing is a systemic act, which involves not only the lungs, but the entire body system. To have a comprehensive clinical picture, it is necessary to have all the patient's data; from this assumption, we can affirm that it is necessary to know all the muscles involved in breathing to understand how to obtain a comprehensive approach for the care and treatment of the patient to improve respiratory capacity. The text reviews the efferent connections of the respiratory centers and cites all the muscles that are involved in the mechanism of breathing and that are controlled and managed by the respiratory centers, starting from the muscular description of the cranial area, the bucco-cervical area, the cervicothoracic area, and the thoracic area. Knowing the function of the respiratory accessory muscles allows us to obtain, in some clinical cases, valuable data that can prove predictive of the diagnostic path of the pathology. This is the first article in the literature, to the authors' knowledge, that attempts to list and include in a single text all the muscles directly or indirectly involved in breathing. The goal of this narrative review article is to remind clinicians and researchers involved in the study of different muscular respiratory responses that we need to analyze and work all the skeletal musculature involved in breathing to better understand what happens in the pathological or physiological phases during breathing. This step will allow us to better individualize the therapeutic and training approach for healthy subjects.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80599"},"PeriodicalIF":1.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Time Trend Analysis of Early Term Births in Greece (1980-2023): Persistent High Rates Raise Public Health Concerns.","authors":"Nikolaos Vlachadis, Chryssi Christodoulaki, Nikolaos Machairiotis, Dimos Sioutis, Ioannis Tsakiridis, Themistoklis Dagklis, Konstantinos Louis, Georgios Petrakos, Maria Siori, Periklis Panagopoulos, Dimitrios Panagiotopoulos","doi":"10.7759/cureus.80606","DOIUrl":"https://doi.org/10.7759/cureus.80606","url":null,"abstract":"<p><strong>Introduction: </strong>Neonates born at 37-38 weeks of gestation have been shown to face a relatively higher risk of mortality and various morbidities compared to those born at full term (39-41 weeks). The aim of this study was to conduct a comprehensive analysis of early term birth rate (ETBR) trends in Greece from 1980 to 2023.</p><p><strong>Materials and methods: </strong>Data on live births in Greece from 1980 to 2023 were obtained from the Hellenic Statistical Authority (ELSTAT), based on birth certificate records. A total of 4,595,020 live births were categorized by gestational age. The annual ETBR was calculated as the number of live births occurring at 37-38 completed gestational weeks (from 37+0 to 38+6 weeks) per 100 total live births. Additionally, ETBR was calculated separately for 37 and 38 gestational weeks, as well as the overall birth rate < 39 weeks of gestation. Time trends were evaluated using joinpoint regression analysis.</p><p><strong>Results: </strong>The ETBR decreased with an annual percent change (APC) of -1.4 (95% confidence interval (CI): -1.8 to -0.9, p = 0.004) between 1980 and 1994, followed by a sharper decline with an APC of -12.8 (95% CI: -14.4 to -8.5, p = 0.005) during 1994-1997. Subsequently, the ETBR increased with an APC of 3.2 (95% CI: 2.0 to 5.6, p = 0.016) from 1997 to 2004. This trend reversed again from 2004 to 2010, with an APC of -2.6 (95% CI: -5.9 to -1.1, p = 0.016), while in the most recent period (2010-2023), the ETBR stabilized (p = 0.630), fluctuating between 41.9% in 2010 and 44.3% in 2012 and 2013. During the study period (1980-2023), the ETBR at 37 weeks increased by an average of 7.1% per year, whereas the ETBR at 38 weeks decreased by an average of -2.1% annually. The overall birth rate < 39 weeks of gestation has remained consistently above 50% over the past two decades (2004-2023). In 2023, the ETBR was 43.7%, while a total of 56.0% of neonates were born < 39 gestational weeks.</p><p><strong>Conclusions: </strong> This study provides a comprehensive analysis of ETBR in Greece, revealing persistently high levels that exceed those of all developed countries. The elevated rate is likely driven by factors such as maternal demographics and obstetrical practices. The alarmingly high levels of ETBR, combined with the country's extremely high preterm birth rates, result in a substantial burden of neonatal morbidity and an increased risk of potential chronic diseases. These findings underscore an enormous public health challenge.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80606"},"PeriodicalIF":1.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-03-14eCollection Date: 2025-03-01DOI: 10.7759/cureus.80554
Adel A Alfayez, Zafer Skef
{"title":"Recurrent Necrotizing Enterocolitis in Late Preterm and Full-Term Babies: A Case Report and Literature Review.","authors":"Adel A Alfayez, Zafer Skef","doi":"10.7759/cureus.80554","DOIUrl":"https://doi.org/10.7759/cureus.80554","url":null,"abstract":"<p><p>Necrotizing enterocolitis (NEC) is a serious inflammatory condition of the intestines that primarily affects premature infants, though it can also occur in full-term infants. Diagnosing and managing recurrent NEC in full-term infants can be particularly challenging, with most requiring surgical intervention upon presentation if medical treatment is insufficient. An approach that emphasizes active medical management while minimizing excessive bowel resection tends to result in better postoperative outcomes, highlighting the need for increased awareness within the healthcare community regarding the complexities of NEC cases. The Security Forces Hospital Program in Riyadh, Saudi Arabia, conducted a study on two cases of necrotizing enterocolitis. The cases involved a full-term baby and a late preterm baby, both of whom had challenging hospital courses and required active care. The study presents a chronological order of the clinical presentation, in-hospital course, and difficulties encountered. The study also includes a brief literature review using PubMed and ProQuest databases. The first case is of a 34+6-week-old baby boy, weighing 2.26 kg at birth, who experienced a normal vaginal delivery but faced complications due to group B <i>Streptococcus</i>. Initially, he showed signs of hypoactivity and a distended abdomen, leading to a diagnosis of sepsis versus necrotizing enterocolitis (NEC). After medical treatment, he was discharged but later returned with worsening symptoms, prompting an ultrasound and subsequent surgery that revealed extensive NEC. Following a stoma procedure and treatment for bowel obstruction, the patient made a full recovery and had a successful stoma closure 10 weeks later. Now, almost four years old, he is thriving and doing well. In the second case, the mother gave birth to a full-term 39 + 2 weeks-old baby boy via normal spontaneous vaginal delivery, weighing 2.51 kg, with no significant antenatal issues. At 10 days old, the baby developed necrotizing enterocolitis (NEC), which was treated before discharge. However, at two months, he was readmitted with sepsis, and an abdominal X-ray showed a thickened bowel loop but no signs of NEC. An ultrasound later indicated ileocolic intussusception, leading to exploratory surgery that revealed NEC and Meckel's diverticulum, but no intussusception was found. The surgery involved creating stomas, and the baby recovered well, with plans for stoma closure 52 days later. He has since been discharged and is making progress in speech therapy after experiencing some delayed speech. Recurrent necrotizing enterocolitis is a rare condition in full-term infants, and its occurrence in de novo cases remains unclear. This condition presents significant challenges in diagnosis and management, potentially leading to long-term gastrointestinal issues or even death, highlighting the importance of prompt diagnosis and appropriate treatment. While medical management is the primary approach, surgi","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80554"},"PeriodicalIF":1.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-03-14eCollection Date: 2025-03-01DOI: 10.7759/cureus.80573
Mohammad N Kheshfeh, Mohammad Y Hajeer, Ahmad S Burhan, Mowaffak A Ajaj, Samer T Jaber, Mhd Firas Al Hinnawi
{"title":"An Innovative Approach to Accelerate Maxillary Canine Retraction With Low-Amperage Direct Electric Current: A Preliminary Clinical Study.","authors":"Mohammad N Kheshfeh, Mohammad Y Hajeer, Ahmad S Burhan, Mowaffak A Ajaj, Samer T Jaber, Mhd Firas Al Hinnawi","doi":"10.7759/cureus.80573","DOIUrl":"https://doi.org/10.7759/cureus.80573","url":null,"abstract":"<p><p>Background and objective Accelerating orthodontic tooth movement is a significant goal for clinicians and patients. This study aimed to investigate the effectiveness of a low-ampere, electrically inducible tooth movement accelerator device. The study focuses on an innovative intraoral removable device designed to expedite the retraction of maxillary canines. Methods This research was conducted in the Orthodontics Department at Damascus University, Syria, between September 2022 and March 2023, and involved seven patients (five females and two males; mean age: 20.85 ± 1.34 years) initially diagnosed with class II, division I malocclusion. The treatment plan included retraction of the upper anterior teeth in two stages following the extraction of the first premolars on each side. Electrical stimulation was applied during the retraction of the maxillary canines using a removable, custom-manufactured device developed by the researchers. Patients were instructed to wear the device for five hours daily. The variables investigated included the rate of canine retraction, safety, and patient acceptance of the device. Results The average rate of canine retraction was consistent, averaging 1.25 ± 0.13 mm/month. No side effects, such as irritation or discomfort, were observed. Patients reported no adverse effects and stated that they would recommend the technique to others. Five out of seven patients found it easy to adapt to the device, while two found it moderately challenging. Conclusions Our findings showed that low-amperage direct current electrical stimulation effectively accelerated orthodontic movement. The maxillary canine retraction was significantly sped up without any adverse effects. Patients responded positively, indicating feasibility and acceptability. This technique could reduce treatment duration, which is pending further validation.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80573"},"PeriodicalIF":1.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-03-14eCollection Date: 2025-03-01DOI: 10.7759/cureus.80556
Abeer Alzuabi, Warda Anam, Mohammed Alblooshi, Shadi Al-Bahri, Guido H Mannaerts
{"title":"Spilled but Not Forgotten: A Retained Gallstone Leading to Colonic Fistula Formation.","authors":"Abeer Alzuabi, Warda Anam, Mohammed Alblooshi, Shadi Al-Bahri, Guido H Mannaerts","doi":"10.7759/cureus.80556","DOIUrl":"https://doi.org/10.7759/cureus.80556","url":null,"abstract":"<p><p>Laparoscopic cholecystectomy (LC) is a routinely performed procedure for symptomatic cholelithiasis, known for its minimal invasiveness and favorable outcomes; however, intraoperative gallbladder perforation and subsequent stone spillage can lead to rare but serious complications such as abscess formation and fistulization. A 38-year-old male patient with a history of sickle cell disease and prior LC presented multiple times with recurrent right upper quadrant (RUQ) pain and sepsis, and over the course of two years, imaging and endoscopic evaluations revealed persistent subhepatic abscesses with a fistulous tract involving the ascending colon. Intraoperative exploration ultimately uncovered a retained gallstone serving as the nidus of this chronic inflammatory process, and a laparoscopic right hemicolectomy with the removal of the stone was performed, leading to the resolution of the patient's symptoms. Although many retained gallstones remain clinically silent, a fraction present late with abscesses or fistulas, complicating diagnosis and increasing morbidity; therefore, comprehensive imaging studies, including CT scans and colonoscopy, are essential for identifying potential complications, and definitive surgical intervention is often required to remove the affected bowel segment and the offending stone. This case underscores the importance of meticulous intraoperative technique and vigilance in patients who develop unexplained or recurrent abdominal sepsis after LC, highlighting that early recognition of this rare complication can guide appropriate management and ultimately reduce the risk of severe morbidity.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80556"},"PeriodicalIF":1.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CureusPub Date : 2025-03-13eCollection Date: 2025-03-01DOI: 10.7759/cureus.80547
Utsav H Gandhi, Shruti D Vyas, Vaishnavi Mane, Shirishkumar N Patel, Hiren H Patadiya, Santosh Kumar, Mainul Haque
{"title":"The Effectiveness of Metronidazole as a Localized Drug Delivery System in the Treatment of Periodontal Diseases: A Narrative Review.","authors":"Utsav H Gandhi, Shruti D Vyas, Vaishnavi Mane, Shirishkumar N Patel, Hiren H Patadiya, Santosh Kumar, Mainul Haque","doi":"10.7759/cureus.80547","DOIUrl":"https://doi.org/10.7759/cureus.80547","url":null,"abstract":"<p><p>Periodontitis is a complex, multifactorial chronic inflammatory condition that impacts the adjacent hard and soft tissues. Microorganisms, especially gram-negative anaerobic pathogens, are a causative factor for periodontal disease. Periodontitis is identified by observing deeper periodontal pockets, clinical attachment loss, and the reduction of alveolar bone, often in conjunction with these indicators. The condition can vary in severity and be classified as mild, moderate, or severe. Scaling and root planing, combined with mechanical debridement, may not adequately reduce the bacterial load; therefore, adding local or systemic antimicrobials is advised as an adjunctive treatment. Commonly utilized local drug delivery agents for patients suffering from periodontitis include tetracycline, metronidazole, minocycline, doxycycline, and chlorhexidine. This system targets the pockets and eliminates the pathogens. Metronidazole is a nitroimidazole compound used commonly against gram-negative anaerobes. Its mechanism lies in four basic steps through which bacterial cell death occurs. A 25% metronidazole gel is used widely in periodontitis patients. The effectiveness of metronidazole as a local drug delivery agent has been evaluated in numerous studies, which have shown improvements in clinical parameters. To achieve favorable clinical outcomes, the non-surgical treatment of peri-implantitis should involve the systemic or local administration of metronidazole. Thus, the role of metronidazole in the emergence of periodontal diseases and its therapeutic uses are investigated in this narrative review.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80547"},"PeriodicalIF":1.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}