An unusual clinical presentation of plasma cell gingivitis related to "Acacia" containing herbal toothpaste

Gingival hypersensitivity reactions to toothpastes: A case series and scoping review

BACKGROUND

Hypersensitivity reactions to toothpastes are rare. The objective of this study was to present the authors' clinical cases in the past 10 years and perform a scoping review of gingival hypersensitivity responses to toothpastes.

TYPES OF STUDIES REVIEWED

The authors reviewed records of documented gingival hypersensitivity reactions to dentifrices at the Postgraduate Clinic of Oral Medicine, Complutense University, Madrid, Spain, from January 2013 through December 2022. Furthermore, the authors conducted a search in PubMed with no date limit for articles reporting these hypersensitivity responses up through October 18, 2023.

RESULTS

Eleven cases were collected from the clinic. Eight gingival hypersensitivity reactions occurred in women, and 6 were associated with cinnamon. The most frequent lesions diagnosed were red gingiva. The discontinuation of the toothpaste led to the disappearance of the lesions. The search yielded 643 references. Thirteen articles were included in the scoping review, all of them case series and case reports, reporting 32 cases. Lesions affected middle-aged women most frequently, the most common hypersensitivity reaction was gingival redness, and the cases implicated toothpastes containing cinnamon and herbal composition.

PRACTICAL IMPLICATIONS

This study provides clues for diagnosing and treating hypersensitivity reactions to toothpastes, which may improve the identification, management, and reporting of these cases.

Pitfalls and Challenges in Oral Plasma Cell Mucositis: A Systematic Review

Plasma cell mucositis (PCM) is an unusual idiopathic disorder characterized by dense infiltrates of plasma cells in submucosa. Clinical phenotypes of oral plasma cell mucositis (o-PMC) are heterogenous. A systematic review has been conducted, aiming to synthesize the available evidence on o-PCM. Literature search, study design, and data analysis were performed following PRISMA guidelines. The SPIDER and the PICO tools were used to structure the research question. In all, 79 case reports and 19 case series on a total of 158 patients (85 females and 73 males; average age: 44.1 years) were identified. Among oral sites involved, gingiva (65.82%) was the most frequent site. The main clinical phenotype was erythema (99.37%). In relation to symptoms, pain (60.76%) was the most reported. On histological examination, all samples showed a dense inflammatory infiltration with predominant plasma cells. The treatment regimens of o-PCM were summarized in six groups: irritant removal; topical/systemic corticosteroids; topical/systemic immunosuppressants/immunomodulators; surgery and similar treatments; radiotherapy and chemotherapy; other therapies, such as antifungals, antibiotics, and antivirals drugs. This is the first systematic review aimed to synthesize the findings of studies on o-PCM. The lack of universally shared information on etiological factors and the absence of international consensus of pharmacological protocols make o-PCM a diagnostic and therapeutic challenge.

Unusual presentation of maxillary plasma cell gingivitis mistakenly treated as aggressive periodontitis. (A case report)

Introduction

A rare benign inflammatory condition of gingiva of unknown etiology, characterized by diffuse and massive infiltration of plasma cells into the sub-epithelial gingival tissue. Plasma Cell Gingivitis (PCG) is characterized by macular lesions that are bright red, velvety, sharply circumscribed, and flat to slightly elevated.

Presentation of case

Female patient 38 years old, complain of mobility of upper right 7 with dull pain and swelling related to it. She also mentioned that the upper wisdom molar at the same side was extracted a year before due to the same reason. Extraction of upper right 7 and excisional biopsy of surrounding soft tissue swelling and by laboratory investigation and analysis to the biopsy we found that the lesion is gingival plasmacytosis. Microscopic examination revealed marked squamous hyperplasia with focal ulceration and diffuse dense subepithelial plasmacytic infiltrate consistent with PCG. At higher magnification, plasma cells were seen without cellular atypia. The individual plasma cells had eccentric round nuclei with cartwheel chromatin patterns and abundant cytoplasm.

Discussion

In the current report, the surgical team performed complete scaling and root planning to remove the associated plaque to decrease any chance of recurrence or plaque induced exacerbation. The patient was instructed to change her habits to avoid the possibility of exacerbation by unknown allergen. The lesion was excised by enblock removal to decrease recurrence possibility.

Conclusion

Plasma cell gingivitis needs radical management and a thorough diagnosis should be done to rule out and differentiate it from the malignant type of plasma cell tumors like multiple myeloma.

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The abnormal presentation of the lesion

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The management of plasma cell gingivitis

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The discussion of different treatment objectives

Gingival plasma cell granuloma: a case report

Plasma cell granuloma is extremely rare in the oral cavity. This paper reports a case of plasma cell granuloma in the oral cavity and reviews the literature. In this case, the plasma cell granuloma occurred in the gingiva, which was bright red and granular. The lesion was resected and diagnosed as gingival plasma cell granuloma by clinical pathological examination. Four months follow-up after operation surgery showed no signs of recurrence. Although gingival plasma cell granuloma is rare, it is easily confused with related diseases and should be identified and followed up closely.

Clinicopathological and immunohistochemical analysis of plasma cell gingivitis- A retrospective study

Background:

This study aims to describe the demographics and clinicopathological characteristics of the cases of plasma cell gingivitis (PCG) reported in our institute, supported by a review of pertinent literature. Further, we investigated the role of the cluster of differentiation CD138, Ki67, CD56, and CD117 immunoexpression in the differential diagnosis of PCG from plasma cell dyscrasias.

Materials and Methods:

All histopathologically confirmed cases of PCG, whose relevant details could be obtained, were included in this study. They were subjected to panel of immunohistochemical markers to exclude plasma cell malignancies. Further, published English literature for PCG since 1970–2020 was reviewed.

Results:

Nine histopathologically confirmed cases of PCG, were retrieved from the archives of our department. The cases comprised 3 males and 6 females with their ages ranging between 14 and 82 years. The plasma cells exhibited equivocal reactivity for kappa and lambda; and immunonegativity for CD56, CD117 with low Ki67 proliferation index. Published literature in English showed 43 cases of PCG were predominantly female; the diffuse involvement of maxilla and mandible was a common finding.

Conclusion:

In addition to kappa lambda reactivity, an immunoprofile of CD138, Ki67, CD56, and CD117 may be used as a diagnostic adjunct to exclude malignant plasma cell lesions in confusing cases.

Clinico-Pathological Profile and Outcomes of 45 Cases of Plasma Cell Gingivitis

Plasma cell gingivitis (PCG) is an infrequent inflammatory disease of the gingiva of unknown etiology, characterized by a dense polyclonal proliferation of plasma cells in the connective tissue. The aim of this study was to present a case series of patients affected by PCG, analyzing demographic, clinical, histopathological, and therapeutic data. A group of 36 females and 9 males with a mean age of 60.3 years was evaluated. Clinically, 25 cases were bullous, a clinical phenotype never reported to date, 4 erythematous, 4 keratotic, 4 verruciform, and 3 ulcerative. On histological examination, pure polyclonal plasma cell infiltrate was detected in 20 specimens, while in 25 specimens it was associated with a mixed infiltrate. The first-line therapy consisted of oral hygiene and topical corticosteroids in all patients. In 25 patients, doxycycline and sulfasalazine were added; in 10 of these patients, the disease persisted, and it was necessary to resort to systemic steroids. This study presented the clinico-pathological profile and outcomes of a case series of PCG. This could be an aid for clinicians to be aware of the heterogeneous clinical phenotype and of the possible pure bullous phenotype of PCG. Further studies are needed to improve the knowledge about this disorder.

A Rare Case of Plasma Cell Gingivitis with Cheilitis

Background

Plasma cell gingivitis (PCG) is a rare condition of the gingiva, characterized histopathologically by infiltration of plasma cells in connective tissue. Hypersensitivity reaction due to antigen is considered as primary etiological factor.

Case Presentation

The present case is of an 18-year-old male patient suffering from gingival enlargement along with cheilitis. Histopathological and immunohistochemistry of tissue revealed lesion as plasma cell gingivitis. After gingivectomy, the follow up of the patient was done for 8 months. Gradual reduction of lip swelling was observed after gingivectomy during subsequent visits.

Conclusion

Early diagnosis is essential as plasma cell gingivitis has similar pathologic changes seen clinically as in leukemia, multiple myeloma, discoid lupus erythematosus, atrophic lichen planus, desquamative gingivitis, or cicatricial pemphigoid which must be differentiated through hematologic examination.

Successful treatment of generalized refractory chronic periodontitis through discontinuation of waxed or coated dental floss use: A report of 4 cases

BACKGROUND AND OVERVIEW

Generalized refractory chronic periodontitis is a periodontal condition that is resistant to conventional therapy. Management of this condition often is frustrating to both the patient and the clinician.

CASE DESCRIPTIONS

The authors present 4 cases of generalized refractory chronic periodontitis characterized by an inflammatory gingival response and progressive bone loss that did not respond to extensive periodontal treatments and regular periodontal care. Histologic examination of affected gingival tissue revealed an abundance of plasma cells, a feature seen in certain oral contact hypersensitivity reactions. The authors suspected that waxed or coated dental floss was the offending contactant, and its removal from the patients' oral hygiene regimens resulted in a dramatic improvement of the periodontal characteristics.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

In cases of periodontal disease as described in this report, dental practitioners should consider the possibility of a contact hypersensitivity reaction to waxed or coated dental floss, whereby the floss exacerbates the condition instead of assisting in its resolution.

Mucosal Lesions in an Allergy Practice

The diagnosis and treatment of mucosal disease with an allergic pathogenesis are challenging. Oral allergy is often a hypersensitivity reaction with variable symptoms and physical exam findings. Clinical diagnosis requires a history of prior allergen exposure, a delay from exposure to clinical findings, and improvement following allergen removal. The past decades have seen great contributions to the field of oral allergy. The aim of this review is to provide an approach to the diagnosis and treatment of oral dermatologic disease with a focus on diseases with an investigated allergic pathogenesis.