PCR array analysis identified hyperproliferation but not autophagy or apoptosis in fibrous epulis

BACKGROUND

The pathogenesis of fibrous epulis is still quite unclear. Our recent genome-wide RNA sequencing analysis revealed that in fibrous epulis, RAS-PI3K-AKT-NF-κB pathway regulates the expression of Bcl-2 family and IAP family genes, leading to increased proliferation and the inhibition of apoptosis. The PI3K/AKT signaling pathway can promote autophagy in human gingival fibroblasts; therefore, the purpose of the present study was to identify whether autophagy is involved in the pathogenesis of fibrous epulis.

METHODS

Differentially expressed genes (DEGs) between fibrous epulis lesions and normal gingival tissues were identified using the PCR array. The expression levels of eighteen autophagy-related (ATG) family genes, twelve B-cell lymphoma 2 (Bcl-2) family genes, and eleven cysteine-dependent aspartate-directed protease (caspase) family genes were validated using quantitative real-time PCR (qRT-PCR). Autophagy induction was determined by measuring microtubule-associated protein light chain 3 (LC3) conversion (LC3-I to LC3-II) by immunoblot analysis.

RESULTS

The PCR array identified six upregulated genes, whereas no genes were expressed at significantly lower levels. The upregulated genes were BCL2, BCL2L1, CXCR4, HSP90AA1, HSPA8, and IGF1, which all belong to the "regulation of autophagy" group but not the "autophagy machinery components" group. qRT-PCR verified that the expression levels of BCL2, BCL2L1 (also known as BCL-XL), and BCL2L2 (also known as BCL-W) were significantly increased in fibrous epulis. No LC3-I to LC3-II conversion was observed.

CONCLUSIONS

The present study reveals that in fibrous epulis, Bcl-2 and Bcl-xL coordinately mediate gingival cell escape from apoptosis, leading to uncontrolled proliferation. Moreover, ATG family genes are not activated, and autophagy is not involved in this process.

Oral focal mucinosis of the palate: a rare disease entity

Oral focal mucinosis (OFM) is an extremely rare, benign oral soft tissue condition; less than 10 documented cases have been reported in the literature in patients under 18 years old. OFM has an unknown aetiology and predominantly presents in the fourth and fifth decades. The pathogenesis of OFM may be due to fibroblast overproduction of hyaluronic acid. Clinically, it remains almost impossible to diagnose definitively, due to its lack of pathognomonic features, therefore such lesions may have multiple differential diagnoses and histological analysis is essential to confirm OFM. We present an unusual presentation of OFM in a 14-year-old female patient. Following excision, focal myxoid degeneration of the connective tissue was apparent. This case highlights this rare condition for consideration in differential diagnosis of clinically similar lesions.

Diagnosis and treatment of oral focal mucinosis: a case series

BACKGROUND

Oral focal mucinosis, the oral counterpart of cutaneous focal mucinosis, is a rare disease. As it has no characteristic clinical or radiological features, diagnosis is established by histopathological and immunohistological examination. We present three cases of oral focal mucinosis occurring in the retromolar (which is extremely rare) and gingival regions.

CASE PRESENTATION

Case 1 involved a 26-year-old Japanese man with radiolucency in the right retromolar region on panoramic radiograph and computed tomography; no obvious protrusion was observed in the region. This finding was clinically diagnosed as a tumor of the retromolar region. Case 2 involved a 60-year-old Japanese woman. A tumor-like mass of tissue was identified on the buccal gingiva at the maxillary right canine and first premolar region. The lesion measured 7 × 6 mm and exhibited elastic hardness and healthy-colored mucosa. The lesion was diagnosed as an epulis. Case 3 involved a 47-year-old Japanese woman. A tumor-like mass of tissue was identified on the buccal gingiva at the maxillary right canine and first premolar region. The lesion measured 10 × 10 mm and exhibited elastic hardness and redness of the surface mucosa. This lesion was also diagnosed as an epulis. Resection was performed in all three cases, and the lesions were histopathologically diagnosed as oral focal mucinosis. Postoperative courses were uneventful and, thus far, there have been no recurrences.

CONCLUSIONS

Although it is difficult to diagnose oral focal mucinosis based on clinical symptoms and imaging findings, the disease should be considered a possibility when diagnosing benign oral tumors. We believe that an emphasis on histopathologic study is essential to confirm the clinical suspicion.

Granulomatosis with polyangiitis: potentially lethal gingival lesions presenting to the dentist

Gingival pathology is a daily presentation, however a small number of systemic conditions can manifest similar to a common gingival condition and have fatal results. Dentist referred 56-year-old woman to Oral and Maxillofacial Surgery department with a 2-week medical history of gingival bleeding not responding to local measures. Biopsy showed eosinophilic infiltrate and vasculitis, and blood tests showed positive markers including cytoplasmic antineutrophil cytoplasmatic antibodies. Granulomatosis with polyangiitis is a rare disease affecting the respiratory tract, blood vessels and kidneys. Oral lesions are rarely the primary presenting feature. When left untreated, most cases are fatal within a year of diagnosis. The diagnosis can only be made when certain criteria are found, including granular oral lesions exhibiting an eosinophilic inflammatory infiltrate on biopsy. With 5% of cases showing intraoral lesions as the primary feature, it is essential that dentists have the knowledge of this rare disease to refer and not to treat as a common gingival condition.

Prevalence of p53 dysregulations in feline oral squamous cell carcinoma and non-neoplastic oral mucosa

Squamous cell carcinoma is the most common malignant oral tumor in cats. The late presentation is one of the factors contributing to the detrimental prognosis of this disease. The immunohistochemical expression of the p53 tumor suppressor protein has been reported in 24% to 65% of feline oral squamous cell carcinomas, but no study has systematically evaluated in this tumor the presence of p53 encoding gene (TP53) mutations. The aim of this retrospective study was to determine whether p53 immunohistochemistry accurately reflects the mutational status of the TP53 gene in feline oral squamous cell carcinoma. Additionally, the prevalence of p53 dysregulation in feline oral squamous cell carcinoma was compared with that of feline non-neoplastic oral mucosa, in order to investigate the relevance of these dysregulations in cancer development. The association between p53 dysregulations and exposure to environmental tobacco smoke and tumor characteristics was further assessed. Twenty-six incisional biopsies of oral squamous cell carcinomas and 10 cases each of lingual eosinophilic granuloma, chronic gingivostomatitis and normal oral mucosa were included in the study. Eighteen squamous cell carcinomas (69%) expressed p53 and 18 had mutations in exons 5-8 of TP53. The agreement between immunohistochemistry and mutation analysis was 77%. None of non-neoplastic oral mucosa samples had a positive immunohistochemical staining, while one case each of eosinophilic granuloma and chronic gingivostomatitis harbored TP53 mutations. Unlike previously hypothesized, p53 dysregulations were not associated with exposure to environmental tobacco smoke. These results suggest an important role of p53 in feline oral tumorigenesis. Additionally, the immunohistochemical detection of p53 expression appears to reflect the presence of TP53 mutations in the majority of cases. It remains to be determined if the screening for p53 dysregulations, alone or in association with other markers, can eventually contribute to the early detection of this devastating disease.

Rare case report of idiopathic gingival fibromatosis in childhood and its management

Idiopathic gingival fibromatosis (GF), also known as gingivomatosis, is a rare condition in childhood, with an unknown aetiology. The oral manifestations of the condition are varied and depend on the severity and age of involvement. This paper describe the case of a 5-year-old male child with extensive gingival enlargement covering almost all the maxillary and mandibular teeth resulted in difficulty with speech, mastication and poor aesthetics. Clinical and radiographic examination along with haematological investigations ruled out any systemic association. The case was managed with conventional scalpel blade surgery along with electrocautery under general anaesthesia yielding good results without any recurrence after a 12-month follow-up. The results revealed that the oral manifestations of GF depend on its severity and the age of onset. Timely intervention can help to prevent associated complications in a growing child.

Non-invasive treatment of pyogenic granuloma by using Nd:YAG laser

Pyogenic granuloma is a 'reactive lesion' in the oral cavity caused due to hormonal imbalance or poor oral hygiene. There are different methods to excise this lesion but most successful is treatment with lasers. Currently, there are different lasers available commercially and are used by clinicians to excise this lesion. In this case report, a 20-year-old female patient reported to the department with a complaint of overgrowth of gingiva on lower canine. It was excised by using neodymium-doped yttrium aluminium garnet laser and the patient was asked for regular follow-up after 1 week and 6 months. The excised lesion was sent to pathology where the lesion was confirmed to be pyogenic granuloma. The patient reported no pain, no blood loss during or postsurgery. Laser is a useful technique for excisional surgeries; it is safe, effective and reduces time of treatment as well as time of healing.

Pigmentation on Gingiva: A Diagnostic Dilemma

Pigmentation on gingiva can be physiologic or pathologic. Gingival pigmentation is present from birth in certain individuals. However, sudden occurrence of pigmentation suggests some systemic association. In the present case, a patient was referred by a physician for biopsy of the tissue along with gingival depigmentation. The depigmentation procedure was performed in both arches, and the biopsy specimen was sent for histopathologic examination. This case highlights the importance of biopsy of gingival pigmentation with a history of sudden occurrence. A biopsy is warranted to distinguish pathologic pigmentation from physiologic.

Factors associated with the risk of gingival disease in patients with rheumatoid arthritis

Gingival disase and rheumatoid arthritis (RA) are linked at both the epidemiologic and pathogenesis levels. In this study, we aimed to identify environmental factors associated with RA and gingival disease and to investigate factors that protect the gingival tissue in RA patients. This retrospective study analyzed 754 RA patients with gingival disease selected from the NHANES database who completed the mobile examination center interview/examination between 1999 and 2004. Data collected included demographics, lifestyle, dietary intake, and biomarkers. The study included 173 RA patients with gingival disease. Multivariate logistic regression analysis showed that the odds of gingival disease were significantly increased with male gender. However, the odds of gingival disease was significantly decreased with increased vitamin C intake (OR = 0.996, p = 0.041), and higher serum vitamin D levels (OR = 0.979, p = 0.011). Given the significant association between the prevalence of gingival disease and RA, identification of risk factors of gingival disease will be useful as a screening tool in national health surveys to improve the management of periodontal disease in patients with RA.

Chronic paracoccidioidmycosis in a woman with Crohn Disease

We report a rare case of chronic paracoccidioidomycosis(PCM) in a woman with Crohn disease in the setting of treatment with azathioprine and mesalazine. Serum tests for antigens to Paracoccidioides brasiliensis, Histoplasma capsulatum, and Aspergillus fumigatus were negative. An incisional biopsy of an oral lesion with periodic acid-schiff and Grocott-methenamine silver stains revealed chronic granulomatous inflammation with multinucleated giant cells with Paracoccidioides brasiliensis within the cytoplasm, confirming the diagnosis of PCM.

Resolution of psoriatic lesions on the gingiva and hard palate following administration of adalimumab for cutaneous psoriasis

We report the case of a 51-year-old man who presented with an atypical inflammatory response of the gingiva and hard palate that was concomitant with widespread cutaneous psoriasis. The patient had discontinued taking adalimumab 6 months prior to presentation, having achieved satisfactory management of his cutaneous lesions; however, he resumed 2 days prior to presentation due to recurrent disease. A gingival biopsy was consistent with oral psoriasis. At a 2-month follow-up, dramatic resolution of oral involvement was evident and the cutaneous psoriatic plaques were greatly reduced in size. The administration of adalimumab for cutaneous psoriasis may concurrently modulate oral dissemination.

A Rare Case of Gingival Cyst in a Child

Gingival cysts, which are more frequently reported as gingival cysts of adults (GCA), are soft tissue cystic lesions of odontogenic origin that are infrequently seen, especially in children. These lesions usually appear as localized firm elevations on the facial gingiva in the anterior segment of the mandible. The purpose of this paper is to present a rare case of a gingival cyst discovered on the palatal aspect of the posterior maxilla in a four-year-old child. The lesion was treated with excisional biopsy.

[Not Available]

Crohn’s disease (CD) is a chronic inflammatory bowel disease whose oral features remain underrated at clinical examination. The aim of the study was to report forerunner orofacial presentations leading to diagnosis of CD among nine patients of mean age 23 between 2008 and 2015. Linear ulcerative buccal lesions, cobblestoning, mucosal tags and perioral erythema are highly evocative and might precede intestinal signs for several years. Oral biopsies revealed highly suggestive lesions of CD for 45% of patients before any intestinal symptom or digestive investigation. Mean time to diagnosis was 14 months. Immunomodulatory therapy (azathioprine, infliximab, adalimumab) was introduced alone or in association for 89% of patients. Early diagnosis could lead to specific therapy, often necessary to reduce severity of lesions and improve quality of life.

Oral focal mucinosis: review of the literature and two case reports

Oral focal mucinosis is a rare condition, clinically characterized by an asymptomatic swelling, without distinct, specific features, which occurs predominantly in adults of the female gender. Its clinical aspect leads to various differential diagnoses, and final diagnosis is only possible by means of histopathological exam, in which a well-delimited myxomatous area containing mucinous material is observed. In the present study, a review of the English-language literature about the lesion, was conducted, covering the period from 1974 to March 2015. We report two new cases, thereby contributing to the knowledge and differential diagnosis of this entity.

A Clinicopathological Study of 52 Feline Epulides

A retrospective study was performed to characterize 52 new cases of feline epulides between 1995 and 2001, with clinical and pathological results classified according to Head's histopathologic criteria for canine epulides. The incidence of the fibromatous, acanthomatous, ossifying, and giant cell epulis were respectively 57.7% (30/52), 7.7% (4/52), 5.8% (3/52), and 28.8% (15/52). Giant cell epulides presented significant differences in clinical behavior compared with the fibromatous type, including rapid growth ( P < .0001), presence of ulcerative changes ( P < .01), and rapid recurrence after surgery ( P < .01) from which euthanasia was judged necessary in 4 cases. Fifteen giant cell epulides were additionally examined in order to characterize the lesion both histochemically and immunohistochemically and to investigate the origin of the multinucleated giant cells (MGCs). Van Gieson staining showed osteoid and woven bone formation in 11 cases. Both the MGCs and a fraction of the mononuclear cells were positive for vimentin, tartrate-resistant acid phosphatase (TRAP), a commonly accepted marker for osteoclasts, and the polyclonal antibody receptor activator of nuclear factor κβ (RANK), a cytokine leading to the differentiation of osteoclast progenitors into mature osteoclasts in presence of its ligand. MGCs were negative for smooth muscle actin, MIB-1, and factor VIII. The giant cell epulis may be a variant of the fibromatous and ossifying epulis in which extensive ulceration and inflammation results in increased osteoclastic activity. The osteoclast-like giant cells are most likely formed from a monocyte/ macrophage-like osteoclast precursor that differentiates into osteoclasts under the influence of mononuclear osteoblast-like stromal cells.

Repair of a Gingival Fenestration Using an Acellular Dermal Matrix Allograft

A case report illustrating the successful treatment of a gingival fenestration with an acellular dermal matrix (ADM) allograft. After 2½ months of healing, the ADM was completely integrated into the soft tissues of the mandibular anterior gingiva with complete resolution of the gingival fenestration, resulting in excellent gingival esthetics.

Graphite oral tattoo: case report

Pigmented oral lesions compose a large number of pathological entities, including exogenous pigmentat oral tattoos, such as amalgam and graphite tattoos. We report a rare case of a graphite tattoo on the palate of a 62-year-old patient with a history of pencil injury, compare it with amalgam tattoos, and determine the prevalence of oral tattoos in our Oral Pathology Service. We also compare the clinical and histological findings of grafite and amalgam tattoos. Oral tattoos affect women more frequently in the region of the alveolar ridge. Graphite tattoos occur in younger patients when compared with the amalgam type. Histologically, amalgam lesions represent impregnation of the reticular fibers of vessels and nerves with silver, whereas in cases of graphite tattoos, this impregnation is not observed, but it is common to observe a granulomatous inflammatory response, less evident in cases of amalgam tattoos. Both types of lesions require no treatment, but in some cases a biopsy may be done to rule out melanocytic lesions.

ACELLULAR HUMAN AMNIOTIC MEMBRANE AS A THREE-DIMENSIONAL SCAFFOLD FOR THE TREATMENT OF MUCOGINGIVAL DEFECTS

This study was conducted to evaluate the usefulness of decellularized and lyophilized extracellular matrix, which was acquired from human amniotic membrane, for surgical closure of the mucogingival defects. Preliminarily, to create a gingival recession defect, silk ligature was applied on the gingival part of the upper incisor in the first (experimental) (n=20) and second (control) (n=20) groups. On the 14th day, the ligature was removed and the damaged gingival tissues were resected. The formed mucogingival defect, in the animals of the first group, was covered with acellular human amniotic three-dimensional scaffold with bone marrow stem cells. Animals with mucogingival defect of the second group were left untreated and served as controls. Unlike the animals from the control group, in animals from the experimental group the mucogingival defect already on the seventh day was completely closed and there was the newly formed epithelial lining, which in shape and color did not differ from the normal. Acellular human amniotic membrane as a three-dimensional scaffold boosts angiogenesis and increases the reparative regeneration of the damaged tissues; and it is well-tolerated by the gingival tissues. Hence, human amniotic membrane might be a suitable alternative to other conventional methods of treating gingival recession.

'Granuloma gravidarum': persistence in puerperal period an unusual presentation

Granuloma gravidarum (GG), an inflammatory lesion, develops in the oral mucosa of pregnant women in response to chronic low-grade irritants and hormonal factors. A persistent granuloma gravidarum post partum and appropriate management strategies are discussed. Patients must be encouraged to undergo regular dental check-ups during the gestational period. Simple oral hygiene measures are highly effective in combating most oral lesions encountered in pregnancy.

The Smile Esthetic Index (SEI): A method to measure the esthetics of the smile. An intra-rater and inter-rater agreement study

PURPOSE

To propose a method to measure the esthetics of the smile and to report its validation by means of an intra-rater and inter-rater agreement analysis.

MATERIALS AND METHODS

Ten variables were chosen as determinants for the esthetics of a smile: smile line and facial midline, tooth alignment, tooth deformity, tooth dischromy, gingival dischromy, gingival recession, gingival excess, gingival scars and diastema/missing papillae. One examiner consecutively selected seventy smile pictures, which were in the frontal view. Ten examiners, with different levels of clinical experience and specialties, applied the proposed assessment method twice on the selected pictures, independently and blindly. Intraclass correlation coefficient (ICC) and Fleiss' kappa) statistics were performed to analyse the intra-rater and inter-rater agreement.

RESULTS

Considering the cumulative assessment of the Smile Esthetic Index (SEI), the ICC value for the inter-rater agreement of the 10 examiners was 0.62 (95% CI: 0.51 to 0.72), representing a substantial agreement. Intra-rater agreement ranged from 0.86 to 0.99. Inter-rater agreement (Fleiss' kappa statistics) calculated for each variable ranged from 0.17 to 0.75.

CONCLUSION

The SEI was a reproducible method, to assess the esthetic component of the smile, useful for the diagnostic phase and for setting appropriate treatment plans.

Primary Retroperitoneal Tumor with Unexpected Gingival Involvement

Retroperitoneal tumors present diagnostic challenges, although a definitive diagnosis can be established based on a histopathological analysis. We herein report the case of a 62-year-old woman with a massive retroperitoneal tumor who was referred to our department for surgery. Although we initially planned to perform an incisional biopsy, we unexpectedly detected gingival swelling, and a gingival biopsy subsequently confirmed a pathological diagnosis of Burkitt's lymphoma (BL). We successfully avoided the use of more invasive diagnostic procedures and were able to promptly initiate chemotherapy. Obtaining an immediate pathological diagnosis is essential for providing successful treatment in such cases, as the disease is potentially curable with chemotherapy. BL should therefore be considered in the differential diagnosis of massive retroperitoneal tumors, highlighting the importance of routine systemic screening.

Enamel defect and gingival enlargement in pediatric patients with kidney disease at Srinagarind Hospital, Khon Kaen University, Thailand

BACKGROUND

Although many complications from kidney disease therapy can be prevented or effectively treated, oral health problems are nevertheless a consequence.

OBJECTIVE

The objective of this study was to explore the prevalence of enamel defect and gingival enlargement in pediatric patients with kidney disease at Srinagarind Hospital, Khon Kaen University, Thailand.

MATERIAL AND METHOD

This cross-sectional study was conducted between January and August 2013, at SrinagarindHospital, Khon Kaen University. Ninety-seven pediatric patients with kidney disease were allowed by their parents to participate in this study. Data were collected from medical records, questionnaires and oral examination records. The enamel defect was recorded using the Developmental Defects of Enamel Index. Gingival enlargement was recorded using the GingivalEnlargement Index. An oral examination was conducted using a mouth mirror, explorer and periodontal probe.

RESULTS

The average age of the pediatric patients with kidney disease was 11.53+3.7years (range, 4-17). The majority of subjects were able to (a) come for an appointment (97.9%), (b) take medication according to the medical directions (93.8%) and (c) avoid inappropriatefoodsfor those suffering kidney disease (84.5%). The prevalence of enamel defect was 27.8%. The most common enamel defects were demarcated opacities (13.4%) or diffuse opacities (9.3%). The prevalence ofgingival enlargement was 16.5%.

CONCLUSION

This study revealed that the prevalence ofenamel defect was 27.8% and the prevalence ofgingival enlargement was 16.5%.

Rare occurrence of lobular capillary hemangioma on the palate: possible mechanism and treatment considerations

Lack of striking clinical presentation makes the diagnosis of vascular lesions a difficult task. There lies a great probability that a case of capillary hemangioma at a rare location like the palate in a pregnant female might be misdiagnosed. Definitive diagnosis can only be made after thorough clinical and histopathological examination. Additional care needs to be exercised in a pregnant female while treating any tumor-like growth, including maintenance of diet and oral hygiene. We present one such case of capillary hemangioma of the palate in a pregnant female, along with treatment considerations.

A quantitative analysis of mast cells in inflammatory periapical and gingival lesions

AIM

The aim of the study was to quantify the presence of mast cells in various inflammatory lesions like periapical granuloma, periapical cyst, inflammatory gingival hyperplasia and pyogenic granuloma. Mast cell degranulation and association with lymphocytes were also recorded in an attempt to understand the role of mast cells in the pathogenesis of these inflammatory lesions.

MATERIALS AND METHODS

The quantification of mast cells was done on toluidine blue stained sections of all the four groups of lesions, using the image analyzer software, Image-Pro-Express (Media Cybernetics, USA).

RESULTS

An increased number of mast cells in various inflammatory lesions with a significant difference between the four groups were noted. Mast cell number tended to be greater in the lesions present in the anterior region of the mouth than in the posterior region of the oral cavity. The mean mast cell number decreased with the increasing age which was directly correlated with the age of the patients. Mast cell site, distribution, degranulation and its association with fibroblasts, lymphocytes and blood vessels were noted.

CONCLUSION

The location of mast cells in different areas, their association with lymphocytes, fibroblasts, endothelial cells, and the phenomenon of degranulation helps to appreciate the release of various mediators and multiple interactions among these cells, leading to increased vascular permeability, angiogenic response, collagen synthesis, regulation of inflammation, bone resorption, and extracellular matrix destruction, thus contributing to the pathogenesis of these inflammatory lesions.

Drug-induced gingival enlargement

OBJECTIVES

Side effect of medicamentous treatment in hypertension therapy and angina pectoris with calcium channel blockers related to fibrotic gingival enlargement were examined.

METHODS

In our study we deal with clinico-histopathological and microbiological knowledge from this field underpinned by two case reports treated with antihypertensive therapy using calcium channel blockers. In the first case report we were largely concerned with microbiological findings from the area of periodontal pseudopockets diagnosed through a DNA analysis and appropriate antibiotic therapy. In a patient treated with a preparation from amlodipine group we proceeded to a complex treatment involving the change of hypertension therapy, introduction of professional and home oral hygiene and also following surgical and prosthetico-aesthetic rehabilitation.

RESULTS

Case Report 1 who was for a long term medicated with a preparation from the nifedipine group of antihypertensives we detected the presence of periodontal pseudopockets with probing depth of 4 to 7 mm with positive BOP and with marked rigid fibrotic gingival enlargement accompanied with considerable foetor ex ore. In a patient from the Case Report 2 who was for a long term medicated with a preparation from the amlodipine group of antihypertensives with large gingival overgrowth angiogenesis was characterized by cuboidal endothelial cell lining. In the samples under a layer of stratified epithelium there was present dense fibrous connective tissue comprising largely of collagen fiber bundles.

CONCLUSION

Bacterial composition in the patient with a high degree of gingival enlargement and periodontal pseudopockets 4 to 7 mm deep represented a typical spectrum of bacteria occuring in chronic forms of periodontitis. However, we cannot determine, if such distribution of bacteria was primary before the application of nifedipine antihypertensives, or it originated later after the formation of typical anaerobic setting of false periodontal pockets.

Management of phenytoin-induced gingival enlargement: a case report

Gingival enlargements may adversely affect speech, mastication, tooth eruption, and esthetics. These enlargements can occur as a result of the administration of certain anticonvulsants, immunosuppressants, and calcium channel blockers. The present case report describes the treatment of a patient with a phenytoin-induced gingival enlargement. A case of gingival enlargement should be treated in a step-wise manner, including consultation with the patient's physician, substitution of the drug, nonsurgical therapy, surgical therapy (if needed), and supportive periodontal therapy after every 3 months. In this case, healing was uneventful, and no recurrences occurred 3 months postoperatively.

[A review of the oro-dento-facial characteristics of hereditary sensory and autonomic neuropathy type III (familial dysautonomia)]

The oro-dento-facial features and dysfunction of children with hereditary sensory and autonomic neuropathy type Ill, known as familial dysautonomia or Riley-Day syndrome, was first described in the scientific literature in 1949. They include dental trauma; dental and soft tissue self-mutilation; normal dental age; normal sequence and timing of eruption and exfoliation of teeth; smaller tooth size; different and disproportional tooth components; normal alveolar bone height; small jaws, mild crowding, and malocclusions. These persons have craniofacial morphology that is different from accepted norms but they resemble norms of their ethnic origin. The subjects can have gray, pale, shiny faces with an asymmetric suffering expression; frontal bossing, with eventual hypertelorism and narrow lips; a low caries rate; drooling, and hypersalivation. They can have changes in salivary composition and content, which influences plaque and calculus and increases the risk of gingival and periodontal diseases. They also have difficulty in controlling oral muscles; a progressive decrease in number of tongue fungiform papillae, accompanied by lack of taste buds; and specific dysgeusia, but a normal sense of smell.

Peripheral giant cell granuloma: a case report

Peripheral giant cell granuloma is a rare exophytic lesion that develops on the gingiva and alveolar ridge. Although the precise etiology of this lesion is unknown, it could represent a local reaction to trauma or irritation. Management requires a surgical excision of the lesion and elaborate recall due to possible recurrence. This report describes the clinical and histopathological features and management of a peripheral giant cell granuloma as it appeared in the maxillary anterior region of a 35-year-old female patient.

Epulis-like gingival angiosarcoma of the mandible: a case report

A 55-year-old woman consulted our hospital for an epulis-like small mass in the anterior region of the mandible. A biopsy of the tumor was performed. Histological analysis showed that the tumor consisted of spindle-shaped and polygonal cells with hyperchromatic nuclei, and intracytoplasmic vacuoles and mitotic figures were scattered. Immunohistochemical staining revealed that the tumor cells were positive for factor VIII-related antigen, CD31, αSMA, and vimentin, but negative for pancytokeratins, S100 protein, neuron-specific enolase, and CD56. The Ki-67 labeling index was more than 50%. Based on these findings, a final pathological diagnosis of angiosarcoma was made. The tumor did not invade into the surrounding tissue. The operation was performed with about a 20-mm surgical margin that was negative for tumor invasion. After a 4-year follow-up, no metastatic lesions were found, and the primary site was covered with a partial denture.

Interrelationship between pyogenic granuloma and peripheral ossifying fibroma: a case report

Pyogenic Granuloma (PG) is an inflammatory hyperplasia which is non-neoplastic in nature. Because of the high incidence of oral PG, critical need exists for its proper diagnosis and treatment. Peripheral Ossifying Fibroma (POF) is a focal reactive overgrowth occurring in young adults. Though clinically similar to PG, it is important to differentiate the lesions based on the histopathological findings that facilitate the management of the lesion, which is diverse in nature when compared to PG. Proper treatment of such overgrowths and appropriate oral hygiene instructions shall ensure no recurrence of the lesion. There are very few case reports published depicting the recurrence of 1 lesion into another reactive overgrowth, and fewer case reports exists describing the interrelationship between these 2 lesions. Hence this case report depicts the interrelation between these 2 reactive fibrous overgrowths having different histomorphologic representation. Also, the importance of histopathologic diagnosis and a proper treatment plan is emphasized to prevent unnecessary distress to the patient regarding the severity of such lesions. An irregular gingival overgrowth occurring in the mandibular anterior region diagnosed histopathologically as PG in a 35 year old female is described. The lesion was excised. Furthermore, it recurred after a year in the same region and the histopathologic diagnosis of the lesion confirmed it as POF. The overgrowth was excised and thoroughly curetted. The case was followed up to 1 year without any signs of recurrence.

Pregnancy tumor mimicking a neoplasm--A case report

Pregnancy brings about a complex series of physiological changes for women. A tumor-like gingival enlargement can occur during pregnancy. The size of the tumor generally increases gradually over a few months as the pregnancy progresses, then shrinks spontaneously after delivery. This case report describes a case of gingival swelling in a 26-year-old woman at five months of gestation. The lesion was not painful and grew very rapidly over a three-week period. The histopathological examination revealed granulation tissue with non-neoplastic proliferation of endothelial cells, suggestive of pregnancy tumor.

Cytological assessment of healing palatal donor site wounds and grafted gingival wounds after application of ozonated oil: an eighteen-month randomized controlled clinical trial

OBJECTIVE

The present study was undertaken to assess the therapeutic effects of topical ozonated oil on early healing of free gingival graft surgical sites.

STUDY DESIGN

Twenty subjects were entered into this triple-blinded, randomized, placebo-controlled clinical trial, designed to evaluate the efficacy of ozonated oil on free gingival graft surgical wounds. Subjects were assigned to either the ozone group, in which ozonated oil was applied to the surgical wound, or the control group, in which non-ozonated oil was used as a control. Patients were postoperatively evaluated by cytological analysis. Cytological analysis consisted of the keratinisation and superficial cell indices measured at baseline, after 24 h, on the 3rd, 7th, 14th and 21st day and 2, 3, 8 and 18 months postoperatively.

RESULTS

Cytological results showed that there was a significant (p < 0.001) improvement in epithelial healing by the 7th, 14th and 21st day and 2, 3 and 8 months postoperatively in the ozone group compared to the control group.

CONCLUSION

The present study showed significant improvement in epithelial healing and gingival health after topical application of ozone-treated plant oil to gingival surgical sites.

Orodental manifestations of facial port-wine stains

BACKGROUND

Patients with facial port-wine stains (PWS) often demonstrate oral manifestations of their disorder; however, the spectrum and prevalence of such findings among a cohort of patients with PWS has not been established. As a result, dermatologists and oral health specialists may be uncertain how to counsel their patients with PWS regarding oral hypervascularity, bony oral changes, and oral hygiene.

OBJECTIVES

We sought to identify physical findings and complications involving the teeth, oral cavity, and perioral structures in individuals with facial PWS.

METHODS

This was a cross-sectional study of 30 patients with facial PWS. Descriptive data were collected through anonymous paired surveys completed by patients and their dentists, and analyzed (Fisher exact test) for trends based on physical findings and stage of the PWS.

RESULTS

The most common orodental manifestations according to patients were enlargement of the lip (53.3%), stained gums (46.7%), abnormal bite (30%), and spontaneous bleeding of the gums (26.7%). Staining of the gingiva correlated significantly with gingival hyperplasia (P = .006), maxillary hyperplasia (P = .014), and widened interdental spaces (P = .002), and in all cases gingival staining predated these findings. Lip hyperplasia was reported more frequently by patients than by their dentists (50% vs 18.2%, P = .008). Orodental manifestations were more common among patients with darker and thicker PWS. Hemorrhage after dental procedures was rare (4.5%).

LIMITATIONS

Modest sample size and difficulty recruiting control subjects are limitations.

CONCLUSIONS

Facial PWS commonly affect the orodental structures, and intraoral staining may predict future complications.

A rare case of generalized pyogenic granuloma: a case report

Gingival enlargement is defined as an overgrowth or increase in size of the gingiva. Enlargement can be of many types depending on etiologic factors like inflammation, drug-induced effects, neoplasm, hormonal imbalance, and systemic involvement (leukemia, etc). Drugs and hormonal imbalance are the most common causes of gingival enlargement. Nonspecific conditioned enlargement, or pyogenic granuloma, is considered an exaggerated conditioned response to minor trauma or chronic irritation. Pyogenic granuloma occurring in the oral cavity is a common phenomenon. However, simultaneously occurring generalized pyogenic granuloma in the oral cavity is a rare entity. Generalized pyogenic granuloma on the back and skin have been reported. This is the first case report of generalized pyogenic granuloma in the oral cavity. A 19-year-old male patient reported with a complaint of difficulty in mastication and generalized swelling of the gingiva that developed within a span of 15 days. Family and systemic history were noncontributory. Based on the clinical findings, histopathology report, and immunohistochemistry result, the patient was diagnosed with generalized pyogenic granuloma. Scaling and root planing were performed as the first phase of therapy followed by external bevel gingivectomy. The patient was followed for 3 months. The patient was advised to visit the clinic for regular maintenance visits for 1 year, as pyogenic granuloma has a tendency to recur.