Gingival Swellings Research Articles

Methotrexate-Associated Lymphoproliferative Disorder With Gingival Swelling

A 63-year-old Japanese man being treated for pemphigus vulgaris with methotrexate (MTX) presented with a fever of unknown origin. His only symptom at onset was mild gingival swelling. Suspected to have gingivitis, he was followed for 1 month. After that, he presented with cervical lymphadenopathy, dysphagia, and bicytopenia, and a diagnosis of MTX-associated lymphoproliferative disorder (MTX-LPD) was finally made by gingival biopsy. He had spontaneous remission after the withdrawal of MTX. When MTX-treated patients complain of fever and oral lesions, even if the oral lesions present as mild gingival swellings, physicians should consider MTX-LPD and perform a diagnostic biopsy.

METACHRONOUS CALCIFYING EPITHELIAL ODONTOGENIC TUMOR WITH LONG-TERM FOLLOW-UP

This is a description of an extremely rare metachronous presentation of calcifying epithelial odontogenic tumor (CEOT) in a 52-year-old woman with a history of synchronous tumors 12 years earlier. The patient presented 2 peripheral CEOTs that appeared clinically as bilateral gingival swellings between the lower first premolar and canine. Both tumors recurred and an additional surgical removal was performed, with no recurrences observed after 3.5 years of follow-up. Eight years after the last consultation, the patient complained of an asymptomatic normochromic nodule of 2.5 cm in the lower posterior gingiva, causing saucerization of the alveolar cortical bone between the second premolar and first molar; the location ruled out the possibility of late recurrence. The diagnosis of CEOT was confirmed microscopically, with no additional tumor after 2 years. Long-term follow-up is recommended for patients with multiple CEOTs for better comprehension of this unique clinical presentation.

Non-Hodgkin’s lymphoma with orbital, oral and systemic manifestations: A case report and review of literature

Non-Hodgkin’s Lymphoma is the commonest among all forms of Lymphomas. It may manifest with nodal and extranodal involvement. Salivary glands, waldeyer’s ring, paranasal sinuses are the common sites of extranodal involvement in the head and neck region. Gingiva, buccal mucosa and palate are the intraoral sites of extranodal involvement. Oral manifestations include painful and mobile teeth, gingival or mucosal swellings which may mimic odontogenic pathologies. Intraoral and orbital presentation of Non-Hodgkin’s Lymphoma is a sign of aggressive behavior and poor prognosis. Lymphomas have a possibility of relatively early diagnosis with systematic examination of oral tissues and the head and neck region, and timely histopathological and radiological investigations. Keywords: Extranodal, NonHodgkin’s Lymphoma, Optic nerve.

Histopathologic Analysis of Gingival Lesions: A 10-Year Retrospective Study

Background: Lesions of the gingiva account for a significant portion of the diagnostic workload of any oral pathology practice. Biopsy is important in establishing a definitive diagnosis. The aim of this study was to determine the relative frequency and distribution of biopsied gingival lesions in a Nigerian population. Methods: This was a retrospective study of all gingival biopsies performed over a 10-year period. Data on age, gender, site (maxillary or mandibular) and histopathological diagnosis were recorded. The lesions were categorized into two groups: non-neoplastic and neoplastic, with the neoplastic lesions further divided into benign and malignant lesions. Data analysis was done using SPSS version 23. Results: There were a total of 501 orofacial biopsies during the period under review, with gingival biopsies accounting for 73 (14.6%) cases. The mean age of subjects was 29.6 ± 20.1 years. There were 48 (65.8%) females and 25 (34.2%) males. Non-neoplastic lesions were 50 (68.5%), while neoplastic lesions were 23 (31.5%). The non-neoplastic lesions had an average age of 25.9 ± 17.7 years, and were encountered most frequently in the 10-19 years age group. Eighteen (36.0%) cases occurred in males, while 32 (64.0%) cases were seen in females. The maxillary gingiva (56.0%) was affected more often than the mandibular gingiva (44.0%). Pyogenic granuloma was the most frequent non-neoplastic lesion, accounting for 35 (70%) cases, followed by peripheral ossifying fibroma (n=6; 12%). The neoplastic lesions had a mean age of 37.1 ± 22.9 years, and consisted of 20 (87%) benign and 3 (13%) malignant lesions. The mean age for benign lesions was 35.3 ± 21.6 years, with a peak occurrence between 20 – 49 years. Females were almost twice more frequently affected than males. The mandibular gingiva accounted for 55% of the benign lesions. The most common benign lesion was fibroma (n=8; 40%) followed by ameloblastoma (n=3; 15%). Malignant lesions accounted for 4.1 % of the biopsied gingival lesions, with a mean age 48.7 ± 33.2 years. There was one case each of Kaposi’s sarcoma, polymorphous low-grade adenocarcinoma and mucosa-associated lymphoma. Conclusion: There is need for histologic examination of all excised gingival swellings.

Low-Grade Myofibroblastic Sarcoma of the Oral Cavity: A Report of Three Cases Illustrating an Emerging Disease in Children

Low-grade myofibroblastic sarcoma (LGMS) is a mesenchymal tumor of myofibroblasts that occurs more frequently in adults. A series of three cases is presented to illustrate that LGMS may also occur within the oral cavity in children and adolescents. The first case (Case 1) occurred intra-osseously in the mandible, while the remaining two presented as gingival swellings and were purely restricted to soft tissue (Cases 2 and 3). The intra-osseous lesion arose in a 7-year-old girl, whereas the gingival lesions were observed in a 12-year-old girl (Case 2) and a 13-year-old boy (Case 3). Histopathologically, all cases were composed of spindle shaped cells arranged into long fascicles showing mild to moderate degree of nuclear atypia. Ki-67 (MIB-1) proliferation activity was relatively low, amounting to 3–5% in all cases. Immunohistochemically, all cases showed smooth muscle actin (SMA) positivity in spindle cells, while desmin, beta catenin, cytokeratin, and CD34 were negative, resulting in a diagnosis of LGMS. In conclusion, current series of three cases of LGMSs that occurred in the oral cavity in a child and two adolescent patients is presented to highlight an emerging disease that requires additional data for further characterization.

Immediate Hypersensitivity Reaction to Composite Restorations

Restorative materials used in dentistry are constantly exposed to salivary components like enzymes that have a high impact on the degradation of these materials and subsequent leaching of some of their constituents which may be harmful to the oral tissues in some patients. Released triethyleneglycolmethacrylate, bisphenol A-glycidyl methacrylate (Bis-GMA), diurethanedimethacrylate (UDMA) and formaldehyde have been detected from incompletely polymerized composite and are implicated in occurrence of various adverse reactions. We present a case of a 60 year old female who had composite restorations done. She later presented with complaints of several episodes of intermittent gingival and cheek swellings of sudden onset adjacent to the restored teeth. The filling was taken off and patient was placed on anti-allergy medications with a close follow-up. This presentation highlights the occurrence of a typical allergy to composite material in our centre. It serves to educate dental practitioners about the awareness of such adverse reactions to dental resin materials and the need to be prompt in management of the condition.

Extranodal Non-Hodgkin’s Lymphoma of the Oral Cavity Presenting as Gingival Swelling: A Case Report

Non-Hodgkin’s lymphoma is a heterogeneous malignancy originating from proliferation of lymphoid cells or their precursors. , we report a case of a 6-year-old Iranian male child admitted at the Department of Oral Medicine, School of Dentistry, Mashhad, Iran, in March 2019. The case was complaining about gingival swellings worsening for one month. Clinical and pathologic examination, complemented by biopsy and immunohistochemistry, confirmed the diagnosis of high-grade B-cell non-Hodgkin’s lymphoma. Treatment was based on chemotherapy. Intraoral involvement of lymphomas might be confused with inflammatory diseases; therefore the dentist has a crucial role in early diagnosis for appropriate management of the disease.

Odontogenic fibroma-like lesions associated with amelogenesis imperfecta: short case

Observation: We present a case of a 21-year-old Pakistani female with hypoplastic amelogenesis imperfecta (AI), microdontia, and multiple gingival swellings overlying impacted teeth. The gingival swellings were diagnosed as AI-associated odontogenic fibroma (OF)-like lesions on histology. Commentary: AI is an inherited enamel defect that may present in association with microdontia, root abnormalities, taurodontism, pulp stones, gingival hyperplasia, and rarely, gingival tumors. These gingival tumors share histologic features with odontogenic fibroma (OF), a benign odontogenic neoplasm, and are referred to as AI-associated OF-like lesions in the literature. Conclusion: AI-associated OF-like lesions are rare, this case will inform oral surgeons and other dental practitioners about this process and its management.

Gingival granulomatosis with polyangiitis (Wegener's granulomatosis) as a primary manifestation of the disease

Granulomatosis with polyangiitis (GPA) is a potentially lethal disease characterized by systemic necrotizing vasculitis, which affects small- and medium-sized blood vessels and is often associated with serum cytoplasmic antineutrophil cytoplasmic antibody. The upper and lower respiratory tract and kidney are the most involved sites, but oral lesions can be identified in 6-13% of the cases, whereas in only 2% of the cases, oral manifestations represent the first signal of the disease usually as gingival swellings or unspecific ulcerations. Without treatment, the mainstay of which is the combination of immunosuppressants and systemic corticosteroids, GPA may run a fatal course. In this report we describe an original case of GPA affecting a 75-year-old female patient referred to our service due to a gingival swelling with 3-month duration. Although the patient was correctly diagnosed and promptly treated, she died 3months after the initial diagnosis.

English

Calcifying Epithelial Odontogenic Tumor (CEOT) is an extremely rare, benign neoplasm, accounting for approximately 1% of all odontogenic tumors. Peripheral CEOTs commonly resemble oral hyperplastic or reactive lesions and are histologically similiar to their intraosseous counterparts. We report an unusual case of peripheral CEOT. A 40-year-old female presented with firm, gingival swellings localized in premolar area of the mandibular lingual gingiva. The presumptive diagnosis was giant cell granuloma. The masses were surgically excised under local anaesthesia with bone curettage. Morphologic features, histochemical and immunohistochemical tests revealed peripheral variant of calcifying epithelial odontogenic tumor. So gingival masses must be carefully evaluated for clinical and histologic evidence of neoplasia.

Primary extra nodal non-Hodgkin′s lymphoma of the oral cavity in a young girl

Primary Non Hodgkin s Lymphoma (NHL) usually arises within the lymphnodes, but 20-30% account for extra nodal sites. Oral cavity, as a primary extra nodal site for NHL, is relatively rare and diverse in presentation, response to therapy and prognosis. We report a 14 year old adolescent girl who presented with multiple gingival swellings, the most prominent one being in the right anterior maxilla. Gingival biopsy showed NHL- diffuse large B cell type. Child was completely cured with chemotherapy and now she is in complete remission and under regular follow up.

Bone lid technique to enucleate bilateral mandibular pindborg tumour

Calcifying epithelial odontogenic tumour (Pindborg tumour) is a rare benign neoplasm. It is an uncommon and locally invasive benign odontogenic tumor. The most characteristic findings are the presence of amyloid-like substance and calcified concentric liesegang rings. We report an unusual case of multifocal CEOT. A 24-year-old female presented with bilateral soft, erythematous, gingival swellings localized in posterior maxilla and mandible. Radiographic findings revealed that extended radiopaque regions related impacted teeth.

Strawberry gingivitis as the first presenting sign of wegener's granulomatosis: report of a case

Wegener's granulomatosis is a rare multi-system disease characterized by the classic triad of necrotizing granulomas affecting the upper and lower respiratory tracts, disseminated vasculitis and glomerulonephritis. Oral lesions as a presenting feature are only encountered in 2% of these cases. Hyperplastic gingival lesions or strawberry gingivitis, is a characteristic sign of Wegener's granulomatosis. The latter consists of reddish-purple exophytic gingival swellings with petechial haemorrhages thus resembling strawberries. Recognition of this feature is of utmost importance for timely diagnosis and definitive management of this potentially fatal disease. A case of strawberry gingivitis as the first presenting sign of Wegener's granulomatosis affecting a 50-year-old Malay male is reported here. The differential diagnosis of red lesions that may present in the gingiva is discussed.

Clinical Periodontal and Microbiologic Parameters in Patients With Crohn's Disease With Consideration of the CARD15 Genotype

Crohn's disease (CD) was reported to have oral manifestations. However, data on periodontal parameters and oral microbiology in CD are rare. Recent studies showed associations of variants in the caspase recruitment domain (CARD)15 gene with CD that are involved in the immune response toward bacterial products. Our aim is to investigate the periodontal status and prevalence of periodontal pathogens in patients with CD under consideration of the CARD15 polymorphism. Oral soft tissue alterations and periodontal parameters of 147 patients with CD were assessed. Subgingival plaque samples were analyzed for the periodontal pathogens Aggregatibacter actinomycetemcomitans (Aa; previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf; previously T. forsythensis), Prevotella intermedia (Pi), and Campylobacter rectus (Cr ) using dot-blot hybridization. CARD15 genotyping was performed with the a polymerase chain reaction (PCR) based assay. A total of 36.7% of patients had oral manifestations predominated by gingival swellings (27.2%) and hyperplastic lesions of the buccal mucosa (20.4%). The mean probing depth and mean clinical attachment level were 3.6 and 3.8 mm, respectively. A total of 57.8% of the patients had a Community Periodontal Index of Treatment Needs (CPITN) score 3, and 31.3% of had a CPITN score 4. The prevalence of Aa, Pg, Pi, Tf, and Cr was 76.9%, 62.6%, 79.6%, 64.6%, and 94.6%, respectively. Pi was significantly less frequent in carriers of CARD15 mutations compared to the wild type (69.7% versus 87.7%; P = 0.008). All other pathogens and clinical periodontal parameters did not differ significantly as to the CARD15 polymorphism. Our findings suggest that patients with CD have an increased prevalence and moderate severity of periodontitis. The colonization of periodontal pathogens, in particular Cr, might be of particular value for the periodontal manifestation of CD. Although a modulating impact on periodontal microbiota can be supposed, our data do not support the role of CARD15 in oral symptoms and periodontal lesions in patients with CD.

Recurrent bilateral gingival peripheral calcifying epithelial odontogenic tumor (Pindborg tumor): A case report

Calcifying epithelial odontogenic tumor (CEOT) is an extremely rare, benign neoplasm, accounting for approximately 1% of all odontogenic tumors. Peripheral CEOTs commonly resemble oral hyperplastic or reactive lesions and are histologically similar to their intraosseous counterparts. We report an unusual case of multifocal peripheral CEOT. A 40-year-old female presented with bilateral soft, painful, erythematous, gingival swellings localized in premolar areas of the mandibular gingiva. The presumptive diagnosis was bilateral pyogenic granuloma. The masses were surgically excised under local anesthesia without bone curettage and both recurred 12 months later. Morphologic features, and histochemical and immunohistochemical tests revealed bilateral peripheral calcifying odontogenic epithelial tumor. There is no clinical or radiographic evidence of recurrence 3.5 years after excision. This multifocal phenomenon has been reported previously only for intraosseous CEOT. Gingival masses must be carefully evaluated for clinical and histologic evidence of neoplasia.

Oral Langerhans cell histiocytosis in Malaysian children: a 40‐year experience

Oral Langerhans cell histiocytosis is generally seen in children. To determine the clinicopathological features of oral LCH in Malaysian paediatric patients. A retrospective study was carried out to determine the clinicopathological features of Langerhans cell histiocytosis (LCH), Letterer-Siwe disease, Hand-Schuller-Christian disease, eosinophilic granuloma, and histiocytosis X occurring in the oral cavity in children, diagnosed histologically in the main oral histopathology laboratory in Malaysia from 1967 to 2007. There were 17 cases (eight girls and nine boys) with age ranging from 1 to 7 years. There were ten Malays, four Chinese, two Indians, and one of other ethnicity. Thirteen cases presented as gingival swellings with six of these cases accompanied with mobility of the teeth. Nine cases involved the mandible, two in the maxilla, and two cases in both the maxilla and mandible. The radiographic findings were mentioned only in nine cases with presence of bony erosion or destruction of the jaw bones. Four cases had punched-out radiolucencies of the skull. The patients also had other systemic signs and symptoms: skin lesions (n = 5), hepatosplenomegaly (n = 2), prolonged fever (n = 2), diabetes insipidus (n = 1), and exophthalmos (n = 1). Two cases were known cases of systemic LCH. The histopathologic features of LCH are easily recognized; however, with the development of immunostaining, the use of CD1a helps in confirming the diagnosis.

Lennox gastaut syndrome, review of the literature and a case report

BackgroundLennox-Gastaut syndrome (LGS) is a severe form of childhood epilepsy that is defined by generalized multiple type seizures, slowness of intellectual growth, and a specific EEG disturbance. Children affected might previously have infantile spasms or underlying brain disorder but etiology can be idiopathic. In South Africa, the incidence of secondary epilepsy is higher than what is found in developed countries resulting in higher incidence of the disease. LGS seizures are often treatment resistant and the long term prognosis is poor.ReportA twenty six year old female, presented with anterior open bite, macroglossia, supragingival as well as subgingival calculus. The gingiva was red, swollen and friable and there was generalized bleeding and localized suppuration. The patient had gingival recession. After periodontal therapy a remarkable improvement in oral health status was noted.ConclusionThe clinical findings in LGS included facial deformities, periodontitis and gingival swellings. Interdisciplinary treatment of these patients is fundamental and oral attention is of outstanding importance. Non-surgical periodontal therapy was effective in controlling periodontal disease in the reported case, but prevention of periodontal and dental diseases is preferable for this high-risk group of patients.

Intraoral features of Apert’s syndrome

To evaluate the intraoral features of patients with Apert's syndrome in treatment at the Hospital of Rehabilitation and Craniofacial Anomalies of University of São Paulo (HRAC-USP), a national reference center for treatment of craniofacial anomalies in Brazil. In this retrospective study, of 56,000 patients registered at HRAC-USP, 36 patients were diagnosed with Apert's syndrome and were either examined or had their medical files evaluated, aiming to characterize lip posture, mouth shape, maxillary hypoplasia, palatal morphology, dental anomalies, and malocclusion. Most patients were characterized as mouth breathers for presenting with hypotonic lips and trapezoidal-shaped mouths. Other frequent findings were the presence of highly arched palates and hypoplastic maxilla, with gingival lateral swellings that increased in size with age. Crowding of teeth and malocclusion were commonly observed, and cases of hypodontia were frequent. Contrary to previous studies demonstrating a high incidence of cleft soft palate, in this study only 1 of 23 patients presented a true cleft. The intraoral features of patients with Apert's syndrome in the population studied match most of the findings in other populations. However, the occurrence of cleft soft palate was unexpectedly low and morphologically normal teeth were found. In addition, hypodontia was frequently observed. Variations in frequency of observations of some characteristics might be related to differences in sample size or population.

Salivary duct fistula and recurrent buccal space infection: a complication of Crohn’s disease

Crohn’s disease is a chronic granulomatous inflammatory bowel disorder of unknown etiology. It can affect any part of the gastrointestinal tract including the oral cavity, but it most commonly occurs in the terminal ileum. The orofacial features of Crohn’s disease have previously been described in a number of reports and include cobblestoning of the oral mucosa, oral ulceration, diffuse labial buccal or gingival swellings, epithelial tags and folds, angular chelitis, lip fissuring, gingivitis, pyostomatitis vegetans, and persistent lymphadenopathy.1,2

The burden of traditional practices, ebino and tea-tea, on child health in Northern Uganda

Traditional medical practices persist today in Northern Uganda; for example, the operations of ebino and tea-tea are frequently performed in childhood. Ebino, or “false teeth”, refers to gingival swellings during the eruption of the primary canine teeth in infants, and consists of the extraction of deciduous canine tooth buds. Tea-tea consists of systematic cuts made on the chest wall when the child has difficulty in breathing. The objectives of this study are to describe the morbidity and mortality related to complications arising from the ebino and tea-tea procedures among children admitted to the paediatric ward of St. Mary's Hospital Lacor in 1999, and to estimate the prevalence of ebino and tea-tea among children aged 0–4 years attending, for any cause, the child welfare department (CWD) of the hospital. The prevalence survey consisted of the examination of 1,995 children attending CWD during a four-week period in 1999 to look for missing primary canine teeth ( ebino), and for “therapeutic” cuts on the chest wall ( tea-tea). In the difficult context of war and social disruption prevailing in Northern Uganda, sustainable methods of data collection and analysis should be utilised to support evidence-based decision-making.