Oral Gingiva Research Articles

The working angle in low-abrasive air polishing has an influence on gingival damage-an ex vivo porcine model.

To investigate the influence of instrumentation angle during low-abrasive air polishing (LAA) on the oral gingiva using an ex vivo porcine model. Six tissue samples from each of 14 porcine mandibles were randomly selected and instrumented. Two different LAA powders (glycine 25μm, tagatose 15μm) were investigated. An application angle of either 30-60° or 90° was selected. Gingival specimens from different mandibles served as untreated references. Gingival biopsies were examined by scanning electron microscopy and paraffin histology for tissue destruction using a five-level scale. LAA caused significantly less tissue damage at a 90° angle than at a 30-60° angle. This effect was seen in both the glycine-based powder arms (p = 0.002, p = 0.046) and the tagatose-based powder arms (p = 0.003, p = 0.011). However, at identical working angles, the two powders did not show significant differences in terms of gingival erosion (p = 0.79 and p = 0.57; p = 0.91 and p = 0.78, respectively). LAA may cause less tissue damage at an application angle of 90°. Consequently, it seems advisable to air-polish the soft tissue as perpendicularly as possible. Additionally, glycine and tagatose LAA powders do not seem to differ in concern of soft tissue damage. Within the limitations of this ex vivo animal model, this study argues for an application that is as close as possible to the 90° angle intending to minimize soft tissue damage. Manufacturer specifications, however, mainly request applications deviating from the right angle. In order to work in interdental areas using LAA safely, the use of subgingival nozzles might be considered.

An unusual case of linear IgA disease affecting only the oral gingiva: a case report

BackgroundWe present a case report on desquamative gingivitis diagnosed as linear IgA disease (LAD), which is a rare autoimmune bullous disease exclusively affecting the oral gingiva. The oral mucosa can be impacted by various autoimmune bullous diseases, and our report focuses on this particular manifestation of LAD.Case presentationThis patient presented with atypical symptoms, as frequent blister formation on the gingiva was the primary clinical manifestation. A combination of systemic and local treatment was administered to the patient. Following the treatment, there was a significant improvement observed in both the erythema and the bullous lesions on the gingiva.ConclusionsA more suitable local treatment strategy should be formulated for patients presenting with oral topical lesions, which clinicians can employ effectively.

Assessment of SARS-CoV-2 entry in gingival epithelial cells expressing CD147.

SARS-CoV-2, the causative agent of the debilitating COVID-19, is mainly transmitted by first infecting nose and lung epithelial cells. The mouth is also believed to be a viral portal site since certain types of oral epithelial cells were shown to express ACE2 receptor. However, it is unclear whether oral epithelial cells are directly infected by SARS-CoV-2. In this study, we addressed whether epithelial cells of the oral gingiva were susceptible to infection. Interestingly, we found that KRT5+ and KRT18+ gingival epithelial cells do not express ACE2 but highly express TMPRSS2 and Furin as well as CD147, which was proposed to be an alternative receptor for SARS-CoV-2. However, using SARS-CoV-2 pseudoviruses containing the spike protein, we observed that gingival epithelial cells were not susceptible to infection due to the lack of ACE2 expression and the inability of CD147 to mediate viral entry. These results strongly suggest that epithelial cells from the gingiva are not susceptible to SARS-CoV-2 and CD147 is not a receptor for the SARS-CoV-2 virus. The susceptibility of oral cells from other oral structures under healthy and pathological conditions still needs to be confirmed to better understand the role of the oral cavity in COVID-19 infection and transmission.

A giant pyogenic granuloma gravidarum in the nasal cavity: A case report.

Pyogenic granuloma (PG) is a benign fibrovascular proliferative lesion on the skin and mucous membranes, but its pathogenesis remains unclear. PG usually occurs on the head and neck region, fingers and toes. The oral gingiva is the most common location for pregnant patients, while it is rarely found in the nasal cavity. This case is notable not only for its uncommon site and size but also for its gradual growth after delivery. Endoscopic surgery can achieve the desired cosmetic effect and a satisfactory airway. A rapidly growing hemorrhagic lesion in the nasal cavity should be considered as a differential diagnosis.

Interleukin-34 permits Porphyromonas gingivalis survival and NF-κB p65 inhibition in macrophages.

Interleukin-34 (IL-34) is a cytokine that supports the viability and differentiation of macrophages. An important cytokine for the development of epidermal immunity, IL-34, is present and plays a role in the immunity of the oral environment. IL-34 has been linked to inflammatory periodontal diseases, which involve innate phagocytes, including macrophages. Whether IL-34 can alter the ability of macrophages to effectively interact with oral microbes is currently unclear. Using macrophages derived from human blood monocytes with either the canonical cytokine colony-stimulating factor (CSF)1 or IL-34, we compared the ability of the macrophages to phagocytose, kill, and respond through the production of cytokines to the periodontal keystone pathogen Porphyromonas gingivalis. While macrophages derived from both cytokines were able to engulf the bacterium equally, IL-34-derived macrophages were much less capable of killing internalized P.gingivalis. Of the macrophage cell surface receptors known to interact with P.gingivalis, dendritic cell-specific intercellular adhesion molecule-grabbing nonintegrin was found to have the largest variation between IL-34- and CSF1-derived macrophages. We also found that upon interaction with P.gingivalis, IL-34-derived macrophages produced significantly less of the neutrophil chemotactic factor IL-8 than macrophages derived in the presence of CSF1. Mechanistically, we identified that the levels of IL-8 corresponded with P. gingivalis survival and dephosphorylation of the major transcription factor NF-κB p65. Overall, we found that macrophages differentiated in the presence of IL-34, a dominant cytokine in the oral gingiva, have a reduced ability to kill the keystone pathogen P.gingivalis and may be susceptible to specific bacteria-mediated cytokine modification.

Junctional epithelium and hemidesmosomes: Tape and rivets for solving the "percutaneous device dilemma" in dental and other permanent implants.

The percutaneous device dilemma describes etiological factors, centered around the disrupted epithelial tissue surrounding non-remodelable devices, that contribute to rampant percutaneous device infection. Natural percutaneous organs, in particular their extracellular matrix mediating the “device”/epithelium interface, serve as exquisite examples to inspire longer lasting long-term percutaneous device design. For example, the tooth's imperviousness to infection is mediated by the epithelium directly surrounding it, the junctional epithelium (JE). The hallmark feature of JE is formation of hemidesmosomes, cell/matrix adhesive structures that attach surrounding oral gingiva to the tooth's enamel through a basement membrane. Here, the authors survey the multifaceted functions of the JE, emphasizing the role of the matrix, with a particular focus on hemidesmosomes and their five main components. The authors highlight the known (and unknown) effects dental implant – as a model percutaneous device – placement has on JE regeneration and synthesize this information for application to other percutaneous devices. The authors conclude with a summary of bioengineering strategies aimed at solving the percutaneous device dilemma and invigorating greater collaboration between clinicians, bioengineers, and matrix biologists.

The Study Effects of Quercus infectoria on the Oral Environment in Gingivitis Patients

Gingivitis is an inflammatory response of the gingival tissues to the metabolic products and pathogenictoxins of bacteria found in oral gingiva. Clinical indicators are redness, edema and swelling of the localgingival tissue.Study comprised of 35 participants of age between 25-45 years who were clinically examined and dividedinto three group gingivitis of female, gingivitis of male and healthy control, These were classified accordingto the values of gingival index score.Q. infectoria were applied topically to participants were suffering from gingivitis, In addition Strips of pHindicator paper were also used to diagnose the effect of Q. infectoria on the pH of the oral pathophysiology.Diagnoses and follow-up product were performed in a dental clinic under the supervision of a dentist byused gingival index for two weeks.The progress of gingival measured in female group in terms of mean, standard deviation and variance were0.7,0.135 and 0.018 before treatment while 0.3, 0.125 and 0.015 after treatment however for male groupwere 0.678, 0.189 and 0.03 before treatment while 0.291, 0.132 and 0.01 after treatment.We observed the great efficacy of the herb product against gingivitis In addition, Significant changes inthe PH of the mouth were also observed after using Q. infectoria, as it was found that PH value is close toneutral and within the normal range for all patients.According to results were due to the fact that Q. infectoria contain large amounts of tannin and othercompounds that constrict vessels and tissues and are effective as an anti-inflammatory for retention of gumtissue there for we recommend used for treatment.

ORAL NEUROFIBROMAS: RETROSPECTIVE STUDY WITH EMPHASIS ON CLINICAL AND MORPHOLOGIC ASPECTS

Objective This study evaluated clinical and histopathologic characteristics of neurofibromas of the oral and maxillofacial complex diagnosed at a referred oral pathology service for a 48-year period. Study Design All cases of neurofibromas were reviewed and clinical data were obtained from patients’ clinical records. Under light microscopy, 2 oral pathologists previously calibrated reviewed all hematoxylin and eosin slides. Results From all 15,375 cases, 24 cases (0.15%) were diagnosed as neurofibromas. Eighteen (75.0%) of the patients with neurofibromas were females and the mean age was 39.1 years. Three patients (12.5%) with neurofibromas had type I neurofibromatosis. Clinically, most of the lesions presented as asymptomatic nodules and the most frequent sites were oral tongue (n = 6; 25.0%) and gingiva (n = 6; 25.0%). Histologically, the lesions were predominantly well delimited (75.0%), exhibiting interlocking bundles of spindle-shaped cells that usually exhibited wavy nuclei, associated with delicate collagen fibers. Fifteen cases had mast cells (37.5%). Meissner bodies and rosettes were not observed. Conclusions Neurofibromas are rare neoplasms in the oral and maxillofacial complex and may be a clinical manifestation of neurofibromatosis type I. Knowledge of clinical and histopathologic features by dentists and oral pathologists is truly important for the correct diagnosis of these lesions.

DENTAL ENAMEL FORMATION AND IMPLICATIONS FOR ORAL HEALTH AND DISEASE.

Dental enamel is the hardest and most mineralized tissue in extinct and extant vertebrate species and provides maximum durability that allows teeth to function as weapons and/or tools as well as for food processing. Enamel development and mineralization is an intricate process tightly regulated by cells of the enamel organ called ameloblasts. These heavily polarized cells form a monolayer around the developing enamel tissue and move as a single forming front in specified directions as they lay down a proteinaceous matrix that serves as a template for crystal growth. Ameloblasts maintain intercellular connections creating a semi-permeable barrier that at one end (basal/proximal) receives nutrients and ions from blood vessels, and at the opposite end (secretory/apical/distal) forms extracellular crystals within specified pH conditions. In this unique environment, ameloblasts orchestrate crystal growth via multiple cellular activities including modulating the transport of minerals and ions, pH regulation, proteolysis, and endocytosis. In many vertebrates, the bulk of the enamel tissue volume is first formed and subsequently mineralized by these same cells as they retransform their morphology and function. Cell death by apoptosis and regression are the fates of many ameloblasts following enamel maturation, and what cells remain of the enamel organ are shed during tooth eruption, or are incorporated into the tooth's epithelial attachment to the oral gingiva. In this review, we examine key aspects of dental enamel formation, from its developmental genesis to the ever-increasing wealth of data on the mechanisms mediating ionic transport, as well as the clinical outcomes resulting from abnormal ameloblast function.

The Expression of IL-8 in Gingival Rattus novergicus After Exposed by Silver Gel Nano Particles 15 µg/ml

<p><strong><em>Background:</em></strong><em> The</em><em> </em><em>uses of silver </em><em>nanoparticle </em><em>are growing so fast, especially in the medical science</em><em>, it’s </em><em>used in many kinds of concentration</em><em>. In dentistry, it’s used </em><em>to decrease halitosis and periodontal diseases, and </em><em>also </em><em>wound healing</em><em> process</em><em>. </em><em>I</em><em>t can affect the viability of the cell</em><em>s, give the bad effects to the human’s health and environment if </em><em>we </em><em>use it in a long-term and in an uncertain concentration. <strong>Purpose</strong></em><strong><em>:</em></strong><em> The aim of the study was to analysis the</em><em> </em><em>healing process of gingival fibroblast in Rattus novergicus after exposed </em><em>by </em><em>15</em><em> </em><em>µg/ml</em><em> </em><em>silver</em><em> gel </em><em>nanoparticles.</em> <strong><em>Materials and Methods:</em></strong><em> This study </em><em>uses </em><em>9 male wistar rats were divided into 3 groups. Group A: Cut (hurt it) in the oral gingiva and exposed to Ag-Np Gel 15 µg/ml for 3 days. After 3 days, they were sacrificed and cut the gingival fibroblast off 3x4 cm size with scalpel. Group B: cut in the oral gingiva and exposed to Ag-Np Gel 15 µg/ml for 5 days. After 5 days they were sacrificed and cut the gingival fibroblast off 3x4 cm size with scalpel. Group C: cut in the oral gingiva and exposed to none for 3 days then cut the gingival fibroblast off 3x4 cm size with scalpel. The expressions of</em><em> IL-8 </em><em>in the </em><em>wound healing </em><em>process were </em><em>painted</em><em> by Im</em><em>m</em><em>unohistochemical </em><em>method</em><em>. This data was analyzed by using the t-test method. <strong>Results:</strong></em><strong><em> </em></strong><em>General characteristic of IL-8</em><em> is </em><em>show</em><em>n in</em><em> brown color im</em><em>m</em><em>unoreactive expression on macrophag</em><em>e</em><em> via immunohistochemic</em><em>a</em><em>l painting with monoclonal antibody anti IL-8</em><em>. </em><em>Mean expression numbers of</em><em> IL-8 </em><em>in the group A = </em><em>11,7</em><em>; group B = 1</em><em>6,3</em><em>; and group C (control) = </em><em>28,3</em><em>. T-test sign.number of group A & C = 0,00</em><em>4</em><em>; group B & C = 0,000. <strong>Conclusion</strong></em><strong><em>:</em></strong><em> The exposure of 15 µg/ml silver gel nanoparticle to gingival fibroblast of Rattus novergicus reduce</em><em>s</em><em> the expressions of</em><em> IL-8 </em><em>in the</em><em> day-3 and day-5 post exposure</em><em>. So, it may accelerate the wound healing process.</em></p><p><strong><em>Keywords:</em></strong><strong><em> </em></strong><em>H</em><em>ealing</em><em>, silver, nanoparticles, </em><em>IL-8</em></p><p><strong><em>Correspondence:</em></strong><em> Kharinna Widowati, </em><em>Department of Science Mouth Disease,</em><em> </em><em>Faculty of Dentistry,</em><em> Hang Tuah</em><em> University,</em><em> </em><em>Arif Rahman Hakim 150</em><em>,</em><em> Surabaya</em><em>,</em><em> </em><em>Email: <span style="text-decoration: underline;"><a href="mailto:kharinna.widowati@gmail.com">kharinna.widowati@gmail.com</a></span></em><em></em></p>

Maturation of the infant microbiome community structure and function across multiple body sites and in relation to mode of delivery.

Human microbial communities are characterized by their taxonomic, metagenomic, and metabolic diversity, which varies by distinct body sites and influences human physiology. However, when and how microbial communities within each body niche acquire unique taxonomical and functional signatures in early life remains underexplored. We thus sought to assess the taxonomic composition and potential metabolic function of the neonatal and early infant microbiota across multiple body sites, and assess the impact of mode of delivery and its potential confounders or modifiers. A cohort of pregnant women in their early 3rd trimester (n=81) were prospectively enrolled for longitudinal sampling through 6 weeks post-delivery, and a second matched cross-sectional cohort (n=81) was additionally recruited for sampling once at delivery. Samples were collected for each maternal-infant dyad across multiple body sites, including stool, oral gingiva, nares, skin and vagina. 16S rRNA gene sequencing analysis and whole genome shotgun sequencing was performed to interrogate the composition and function of the neonatal and maternal microbiota. We found that the neonatal microbiota and its associated functional pathways were relatively homogenous across all body sites at delivery, with the notable exception of neonatal meconium. However, by 6 weeks, the infant microbiota structure and function had significantly expanded and diversified, with body site serving as the primary determinant of the bacterial community composition and its functional capacity. Although minor variations in the neonatal (immediately at birth) microbiota community structure were associated with Cesarean delivery in some body sites (oral, nares, and skin; R2 = 0.038), this was not true in neonatal stool (meconium, Mann-Whitney p>0.05) and there was no observable difference in community function regardless of delivery mode. By 6 weeks of age, the infant microbiota structure and function had expanded and diversified with demonstrable body site specificity (p<0.001, R2 = 0.189), and no discernable differences in neither community structure nor function by Cesarean delivery were identifiable (p=0.057, R2 = 0.007). We conclude that within the first 6 weeks of life, the infant microbiota undergoes significant reorganization that is primarily driven by body site and not by mode of delivery.

Gingival cell smoke exposure disrupts skeletal muscle metabolic function

Cigarette smoke exposure compromises health through damaging multiple physiological systems, including disrupting skeletal muscle metabolic function. The purpose of this study was to determine the role of oral gingiva in mediating the deleterious metabolic effects of cigarette smoke exposure on skeletal muscle metabolic function. Using an in vitro conditioned‐medium cell model, skeletal muscle cells were incubated with medium from gingival cells treated with normal medium or medium containing suspended cigarette smoke extract (CSE). Following incubation of muscle cells with gingival cell conditioned medium, muscle cell mitochondrial respiration and insulin signaling and action were determined as an indication of overall muscle metabolic health. Skeletal muscle cells incubated with conditioned medium of CSE‐treated gingival cells had a profound reduction in mitochondrial respiration and respiratory control. Furthermore, skeletal muscle cells had a greatly reduced response in insulin‐stimulated Akt phosphorylation and glycogen synthesis. Altogether, these results provide a novel perspective on the mechanism whereby cigarette smoke affects systemic metabolic function. In conclusion, we found that oral gingival cells treated with CSE create an altered milieu that is sufficient to both disrupt skeletal muscle cell mitochondrial function and insulin sensitivity.

Oral Gingival Cell Cigarette Smoke Exposure Induces Muscle Cell Metabolic Disruption.

Cigarette smoke exposure compromises health through damaging multiple physiological systems, including disrupting metabolic function. The purpose of this study was to determine the role of oral gingiva in mediating the deleterious metabolic effects of cigarette smoke exposure on skeletal muscle metabolic function. Using an in vitro conditioned medium cell model, skeletal muscle cells were incubated with medium from gingival cells treated with normal medium or medium containing suspended cigarette smoke extract (CSE). Following incubation of muscle cells with gingival cell conditioned medium, muscle cell mitochondrial respiration and insulin signaling and action were determined as an indication of overall muscle metabolic health. Skeletal muscle cells incubated with conditioned medium of CSE-treated gingival cells had a profound reduction in mitochondrial respiration and respiratory control. Furthermore, skeletal muscle cells had a greatly reduced response in insulin-stimulated Akt phosphorylation and glycogen synthesis. Altogether, these results provide a novel perspective on the mechanism whereby cigarette smoke affects systemic metabolic function. In conclusion, we found that oral gingival cells treated with CSE create an altered milieu that is sufficient to both disrupted skeletal muscle cell mitochondrial function and insulin sensitivity.

Apoptosis of Rattus novergicus gingival fibroblasts caused by silver nano-particles gel exposure

Background: The use of silver nanoparticle are growing, especially in medical science. It’s used in many concentration. In dentistry, it’s used to decrease halitosis, periodontal diseases, and wound healing. It can affect the viability of the cells, give bad effects to the human’s health and environment if used in a long duration and in certain concentration. Purpose: The purpose of this study was to learn the apoptosis of gingival fibroblasts in Rattus novergicus which is exposed with 15 µg/ml silver nano-particle gel by the expression of caspase-3. Method: This study used 9 male wistar rats and were divided into 3 groups. Sample in group A were cut (hurt) in the oral gingiva and exposed to Ag-Np gel 15 µg/ml for 3 days. After 3 days, they were sacrificed and cut the gingival fibroblasts off 3x4 cm size with scalpel. Samples in group B were cut in the oral gingiva and exposed to Ag-Np Gel 15 µg/ml for 5 days. After 5 days they were sacrificed and the gingival fibroblasts off 3 x 4 cm with a scalpel. Samples in group C were cut in the oral gingiva and exposed to none for 3 days then cut the gingival fibroblasts off 3 x 4 cm size with scalpel. The expressions of caspase-3 in the apoptotic and wound healing process were analyzed by Immunohistochemical test. This data was analyzed by using the t-test method. Result: Mean expression numbers of caspase-3 in the group A=5.67; group B=11.33; and group C (control)=18.67. T-test sign.number of group A and C=0.009; group B & C=0.000. Conclusion: The exposure of 15 µg/ml silver gel nanoparticle to gingival fibroblasts of Rattus novergicus reduces the expressions of caspase-3 in the day-3 and day-5 post exposure. The amounts of cell death through the apoptotic pathway which were analyzed by the expressions of caspase-3 will decrease too.

Comparison of the effects of small titanium plate rigid internal fixation and intermaxillary fixation in the treat-ment of simple mandibular fracture

Objective To compare the clinical efficacy of small titanium plate rigid internal fixation and intermaxillary fixation in the treatment of simple mandibular fracture,and to explore the best treatment method for the reduction of fractures of the mandible. Methods 252 cases with simple fractures of the mandible were randomly divided into the two groups.126 cases of group A were treated by rigid internal fixation,126 cases of group B were treated by intermaxillary fixation.The patients were followed up for 6 months after operation.The complications,occlusion and mouth opening were compared between the two groups.And then,the data were analyzed. Results 120 cases of group A occlusal relation recovered to normal,the appearance and function were recovered well.The average mouth opening was 3.90cm.4 cases got postoperative infection,1 case titanium plate was broken.118 patients of B group occlusal relation recovered to normal,the appearance and function were restored,no case of infection and clamp plate broken.10 cases happened bad oral health condition,gingiva swell and teeth loosen.8 cases complicated with bad occlusion.There were no statistical differences between A and B group about occlusion and mouth opening(χ2= 0.30,0.86,all P> 0.05). Conclusion Two treatment methods are effective in the treatment of simple mandibular fracture,rigid skillfully master indication to get best efficacy. Key words: Mandibular fractures; Jow fixation techniques

Oral Manifestation of Systemic Diseases

The mouth is a mirror of health or disease, a sentinel or early warning system. The oral cavity is an important anatomical location with a role in many critical physiologic processes, such as digestion, respiration, and speech. It is also unique for the presence of exposed hard tissue surrounded by mucosa. The mouth is frequently involved in conditions that affect the skin or other multi-organ diseases. In many instances, oral involvement precedes the appearance of other symptoms or lesions at other locations. As the gateway to the body, a constant barrage of invaders like bacteria, viruses, parasites, and fungi, challenges the mouth. Many systemic diseases have oral manifestations. These lesions develop on the oral mucosa, tongue, gingiva, dentition, periodontium, salivary glands, facial skeleton, extraoral skin and other related structures. These oral manifestations must be properly recognized if the patient is to receive appropriate diagnosis and referral for treatment.

Metastasis of mesothelioma to the maxillary gingiva.

Malignant mesothelioma predominantly arises from the serosal surfaces of the pleural or peritoneal cavity. There is currently no effective standard treatment for mesothelioma and the prognosis for patients is poor; the majority of patients with malignant mesothelioma succumb between 12 and 17 months following diagnosis. The association of all forms of malignant mesothelioma with asbestos exposure has been well documented. However, metastasis to the oral gingiva is rare, as only four cases have previously been reported; two cases of metastasis to the tongue and four cases to the jaw bone. In the current report, the case of a 62-year-old male with metastatic mesothelioma is presented. To the best of our knowledge, this is the first report regarding the metastasis of this type of neoplasm to the maxillary gingiva.

MiR-218 regulates focal adhesion kinase–dependent TGFβ signaling in fibroblasts

Scarring, which occurs in essentially all adult tissue, is characterized by the excessive production and remodeling of extracellular matrix by α-smooth muscle actin (SMA)-expressing myofibroblasts located within connective tissue. Excessive scarring can cause organ failure and death. Oral gingivae do not scar. Compared to dermal fibroblasts, gingival fibroblasts are less responsive to transforming growth factor β (TGFβ) due to the reduced expression, due to the reduced expression and activity of focal adhesion kinase (FAK) by this cell type. Here we show that, compared with dermal fibroblasts, gingival fibroblasts show reduced expression of miR-218. Introduction of pre-miR-218 into gingival fibroblasts elevates FAK expression and, via a FAK/src-dependent mechanism, results in the ability of TGFβ to induce α-SMA. The deubiquitinase cezanne is a direct target of miR-218 and has increased expression in gingival fibroblasts compared with dermal fibroblasts. Knockdown of cezanne in gingival fibroblasts increases FAK expression and causes TGFβ to induce α-smooth muscle actin (α-SMA). These results suggest that miR-218 regulates the ability of TGFβ to induce myofibroblast differentiation in fibroblasts via cezanne/FAK.

Aesthetic gingival depigmentation procedures: clinical and patient responses

Background Oral pigmentation is a discoloration of the oral mucosa or gingiva due to a variety of lesions and conditions associated with several endogenous and exogenous etiologic factors and occurring in all races of mankind. Gingival hyperpigmentation may cause aesthetic problems and embarrassment especially when smiling.

Pemphigus vulgaris macroscopically and cytologically resembling oral squamous cell carcinoma

We describe the clinical, macroscopic, cytological, histopathological, immunohistochemical, serodiagnostic and aspects of pemphigus vulgaris (PV) in the oral gingiva that clinically mimicked oral squamous cell carcinoma (OSCC) in a 57-year-old Japanese man. He developed slight haphalgesia of the buccal gingiva around teeth numbers 18 and 19 2 years ago. A dentist diagnosed intractable ulcer, but the patient ignored the condition for about 2 years until a sharp pain in the gingiva worsened. He consulted an otolaryngologist, who referred the patient to our hospital under a cytological diagnosis of OSCC. An oral examination revealed several extensive painful erosions/ ulcers from the buccal and lingual gingiva around teeth numbers 18 to 21 to the distal alveolar mucosa of no. 18 and the buccal and lingual gingiva around tooth number 31. A presumptive diagnosis of PV with dysplastic changes was determined from cytological smears. The cytological Nikolsky test was positive. The diagnosis of PV was confirmed from clinical and histopathological findings of a biopsy specimen obtained from the perilesional site. Although the definitive diagnosis of PV required only 2 weeks after this patient presented at our hospital, 2 years had elapsed since the onset of oral lesions.