Search

Competing Interests: Disclosures None of the authors reported any disclosures.

Background: Many gingival lesions are not induced by plaque. The aim of this study was to analyze the frequency of biopsied non-plaque-induced gingival lesions (NPIGL) in a Chilean population., Methods: One thousand twelve cases of biopsied gingival lesions with confirmed anatomopathologic diagnosis were included, from the records of the Oral Pathology Referral Institute (OPRI), Faculty of Dentistry, University of Chile, between years 1990 and 2009., Results: The most frequent non plaque-induced gingival lesions categories from biopsied cases included hyperplastic lesions, malignancies and benign neoplasms. The most frequent diagnoses in each category were fibrous hyperplasia (35.47%), squamous cell carcinoma (3.85%) and giant cell fibroma (2.08%), respectively. From all lesions, only 8.3% fitted in the specified categories of the current classification of periodontal diseases., Conclusions: The most frequent biopsied NPIGL were hyperplastic lesions and neoplasms. These categories represent relevant lesions to be included in a future periodontal classification system to improve the care needs of the patients, as well as early diagnosis and treatment.

Plasmacytosis of the mucous membrane is a rare, benign, inflammatory condition of poorly understood aetiology that affects the mucous membranes. Most reported cases involve the gingival tissues, larynx, and occasionally the lips. We describe an interesting case of orofacial plasmacytosis that affected the lower lip, mandibular gingiva, and buccal mucosa. It mimicked an oral squamous cell carcinoma and presented a management dilemma., (Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: 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 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.

Unlabelled: Oral lesions commonly diagnosed in newborns and infants include Epstein's pearls, Bohn's nodules, dental lamina cysts and congenital epulis. Nevertheless, intriguing cases which have rarely been reported in the literature are encountered by clinicians. This paper reports a case of an unusual white lesion in a 10-month-old child which resolved spontaneously. However, histological examination proved it to be a foreign body., Clinical Relevance: Infants tend to explore things with their mouths; hence they put anything they can hold into it to determine the size and texture. This case serves to illustrate that the unexpected can occur and that, in children, the differential diagnosis should include a foreign body.

A case of intraoral molluscum contagiosum involving the right distal alveolar bridge of an immunocompetent person is reported. A review of the literature, with only five previously published cases, revealed that involvement of the oral soft tissues is rare.

Background: Wegener's granulomatosis (WG) is a complex disease, characterized by a necrotizing vasculitis that usually involves the upper airways, lungs, and kidneys; occasionally, other organs may also be affected. Because of the severity and rapid progression of the disease, early diagnosis and treatment are critical; this type of vasculitis is potentially fatal if left unchecked., Methods: A 64-year-old woman presented with a chief complaint of a gingival mass that had appeared 2 months before and had grown rapidly. In the previous months she complained of malaise without weight loss. An intraoral examination revealed the presence of a solitary gingival mass, 2 cm in diameter, affecting the area above the upper central incisors. The lesion displayed a granular, erythematous, speckled surface with petechiae, characteristic of WG., Results: A biopsy of the lesion, a thoracic computed tomography, and the presence of high titers of antineutrophil cytoplasmic antibodies (ANCA) in the blood established the diagnosis of WG. An initial combination therapy of prednisone and cyclophosphamide successfully abated most of the patient's symptoms., Conclusions: The occurrence of an extremely rare tumor-like form of strawberry gingiva was the primary clinical sign that led to a diagnosis of WG. This case emphasizes the important role of the dentist in the diagnosis of this potentially fatal disease.

This is a case report of localized aggressive periodontitis associated with unusual gingival enlargement. There was difficulty both clinically and histologically in deciding whether the gingival enlargement was a pyogenic granuloma or a Kaposi sarcoma. The diagnosis of Kaposi sarcoma was eventually ruled out by the failure of immunohistopathological examination to demonstrate the presence of HHV-8 DNA markers, and by the clinical response of the lesions to antimicrobial agents. Once a definitive diagnosis was made, the patient was treated conventionally.

The pigmentation is the physiological or pathological accumulation of a pigment in a tissue. Physiological pigmentation in gingiva which is a part of masticatory mucous membranes depends on the activity of the melanocytes. These non keratinocytic cells include the melanosoma where an endogenous pigment, the melanin, is synthesized. Quantitative or qualitative disruption of mucous pigmentation leads to the apparition of pigmented lesions. When melanocytes are directly concerned, the lesions can be of intrinsic origin, such as oral mucosa melanoma, the nevus, pigmented oral lichen planus etc. Pigmented lesions can be also of extrinsic origin caused by medicaments, dental materials, tobacco etc. In this article, gingival pigmentations are described to allow practitioner to elaborate a differential and positive diagnosis of gingival pigmented lesions and to facilitate an early detection of these lesions particularly the gingival melanoma.

This report describes the case of an 82-year-old woman who presented with the chief complaint of a mild pain and gingival swelling of 2-months' duration in the buccal aspect of her mandibular left premolar region. The condition was initially diagnosed as a periodontal abscess and was treated as such by the referring clinician. The initial periapical radiograph provided by the clinician demonstrated horizontal alveolar bone resorption associated with active periodontal disease, which appeared to be more severe between the 2 premolars adjacent to the swelling. After more detailed clinical evaluation of the area and examination of the adjacent teeth, including vitality testing, it was concluded that the condition was not related to dental or periodontal disease. Consequently, a biopsy specimen was taken, and the histopathologic examination of the lesion proved it to be an odontogenic keratocyst. The case is reported because of the unusual clinical and radiographic findings associated with this lesion. Early diagnosis and appropriate treatment of odontogenic keratocyst can reduce the possibility of recurrence. However, misinterpretation of such a condition as endodontic or periodontal disease may lead to incorrect treatment planning and possibly unnecessary complications.

An otherwise-healthy 11-month-old white girl presented with a polyp-like lesion on the anteromedial part of the maxillary alveolar ridge. It looked like a congenital epulis, but histological examination showed fascicles of smooth muscle cells dispersed in collagenous stroma with a few peripheral nerve bundles that were intermingled with smooth muscle fibres. The muscle cells stained strongly for desmin and alpha-smooth-muscle actin. However, S-100 was found only in peripheral nerve bundles. It was therefore a leiomyomatous hamartoma.

Pyogenic granuloma is one of the inflammatory hyperplasias seen in the oral cavity. This term is a misnomer because the lesion is unrelated to infection and in reality arises in response to various stimuli such as low-grade local irritation, traumatic injury or hormonal factors. It predominantly occurs in the second decade of life in young females, possibly because of the vascular effects of female hormones. Clinically, oral pyogenic granuloma is a smooth or lobulated exophytic lesion manifesting as small, red erythematous papules on a pedunculated or sometimes sessile base, which is usually hemorrhagic. The surface ranges from pink to red to purple, depending on the age of the lesion. Although excisional surgery is the treatment of choice for it, some other treatment protocols such as the use of Nd:YAG laser, flash lamp pulsed dye laser, cryosurgery, intralesional injection of ethanol or corticosteroid and sodium tetradecyl sulfate sclerotherapy have been proposed. Because of the high frequency of pyogenic granuloma in the oral cavity, especially during pregnancy, and necessity for proper diagnosis and treatment, a complete review of published information and investigations about this lesion, in addition to knowledge about new approaches for its treatment is presented.

A seven-day-old female newborn was examined for a mass protruding from the mouth. Physical examination showed a smooth and pedicled mass with normal mucosal tissue, 3x2 cm in size, originating from the maxillary alveolar edge on the upper incisor and canine teeth. The mass was excised under general anesthesia. Histopathologic diagnosis was congenital epulis. No recurrence was observed during postoperative six months. Congenital epulis is a benign tumor. It should be dealt with surgically if it significantly affects respiratory and alimentary functions.

An exceedingly rare case of gingival plasma cell granuloma is reported in a 40-year old female patient. The case presented as an exophytic mass of gingiva, clinically resembling traumatic fibroma. Histopathologic findings revealed dense sheets of plasma cells infiltrate. Immunohistochemistry for kappa and lambda light chains showed polyclonal (benign) staining pattern confirming a diagnosis of plasma cell granuloma. It is important to recognise this peculiar lesion because of its highly unusual incidence in involving the periodontium. Clinical features are usually suggestive of traumatic fibroma (benign) but histopathologicaly in early stages it closely resembles plasmacytoma (malignant). This case highlights the need to biopsy unusual lesions to rule out potential neoplasms and also emphasizes the need to submit all the excised tissue for histological examination regardless of clinical impression and/or perceived surgical success. Only by such practice can rare lesion of this type be diagnosed and their incidence studied.

A seven-year-old neutered/male Siberian Husky-cross dog was referred for evaluation of a gingival mass. Two years previously, the referring veterinarian had resected an ossifying epulis from the same area between the maxillary left first and second premolars. The neoplasm recurred 4-months after the original surgery. En bloc resection provided tumor-free margins. An oral examination 12-months following surgery indicated no gross signs of recurrence.

Molluscum contagiosum (MC) occurring on the face, lips, and perioral region is a relatively common manifestation of this infectious disease. MC of the intraoral mucosa has been documented, but is rare. This report details the case of a 52-year-old HIV-seropositive man with MC of the gingiva. A review of the literature discloses only 4 previously reported cases of intraoral MC.

Plasma cell granulomas (pseudotumors) are rare benign, tumor-like proliferations composed chiefly of plasma cells that manifest primarily in the lungs, but may occur in various anatomic locations. We report this case of a 54-year-old male who presented with an unusual maxillary anterior gingival overgrowth treated by excisional biopsy. Histological examination revealed a dense inflammatory cell infiltrate containing mainly plasma cells. Immunohistochemistry for kappa and lambda light chains showed a polyclonal staining pattern confirming a diagnosis of plasma cell granuloma. Intraoral plasma cell granuloma is exceedingly rare, although case reports documenting such lesions have been reported. This case highlights the need to biopsy unusual lesions to rule out potential neoplasms.

A slowly enlarging gingival mass with a reddish-purple surface is observed in a school-age boy. The lesion was first noted 3 months ago during a routine oral examination but recently it has increased in size and interferes with eating. A periapical radiograph demonstrated focal loss of the alveolar crestal bone in the mandibular incisor region. The diagnosis of peripheral giant cell granuloma, a benign reactive gingival lesion, is confirmed by histopathologic examination. Early detection and excision of this hyperplastic nodule is important to minimize potential dentoalveolar complications.

Background: A computerised morphometric analysis of some vascularisation aspects of epulides is presented. The aim of this study is to evaluate the correlation between morphometric aspects and histological classification of epulides and to investigate its usefulness for the histopathologic diagnosis., Methods: The study was carried out on epulides from 72 patients (30 males, 42 females, age-range 16-60). Epulides were fixed in alcohol, paraffin embedded, and stained with haematoxyilin eosin, thereafter epulides were histopathologically classified as granulomatous epulides, fibrous epulides and giant cell epulides. Images of histological samples were then digitised, and by an image analysis system some morphometric vessels characteristics were evaluated: percent image area occupied by vessels, vessels number, mean vessels area and standard deviation of vessels area. Finally, the correlation between morphometric data and the histological classification of epulides was evaluated., Results: The statistic evaluation of morphometric data allowed to classify epulides in six groups characterised by a various degree of vascularisation, these groups showed a good correlation with histopathological classification., Conclusions: The morphometric analysis of vessels is a powerful aid for the histopathologic diagnosis and for a better knowledge of the etiopathogenetic factors of epulides.

An unusual pseudosarcomatous lesion of the oral mucosa is described in a 43-year-old woman. It presented as an aggressive ulcerative mass in the mandibular retromolar gingiva of one month's duration. The lesion was composed of florid myofibroblastic and fibrohistiocytic proliferations with infiltrative margins in an inflammatory background and was considered to be an inflammatory pseudotumor. Although the tumor appeared to have been incompletely excised, the patient remains free of disease at 1 year follow-up.

A peripheral giant cell granuloma can be seen as a pedunculated or broad-based lesion. Such lesions occur after age 20 years, with 50 percent of patients 40 to 59 years old. Frequently, there is a history of trauma to the region.

Purpose: The primary objective of this study was to determine the most commonly biopsied gingival lesions in a university-based school of dentistry biopsy service., Methods: The biopsy service at the Louisiana State University Medical Center School of Dentistry accumulated 30,056 cases during a 24-year period (1969 to 1992). Microcomputer technology was used to sort these cases to study the gingival lesions including the incidence of neoplasm and epidemiologic factors of age, gender, and race., Results: Of the 30,056 biopsies submitted for diagnosis, 3,859 (12.8%) were taken from the gingiva. The most common diagnoses for gingival lesions were periodontal disease, fibrous hyperplasia, pyogenic granuloma, peripheral ossifying fibroma, and epithelial hyperplasias/hyperkeratoses. Benign and malignant neoplasms made up 15.5% of the cases. The largest number of cases was from individuals between the ages of 30 and 39 (18.2%). Of the biopsies submitted, 63.3% were from female patients, and 85.8% of the cases were from Caucasian patients., Conclusion: Gingival lesions often are detected by dental hygiene and dental professionals. Knowledge of the frequency and presentation of the most common gingival lesions is beneficial in developing a clinical impression of such lesions encountered in practice.

Case report of a voluminous gingival granular cell tumor (congenital epulis). Literature review concerning diagnosis, pathology, complications, evolution and treatment of this kind of tumor.

A case is reported of an unusual vascular lesion on the gingiva of an 11-year-old boy which clinically and histopathologically did not fit well into any current classification of vascular lesions. The lesion presented as a firm nodular swelling of the buccal and lingual gingiva which had been present for 9 years. The term endovascular papillary haemangioma is suggested. Histopathologically it had features in common with a number of benign vascular lesions, as well as with some more sinister locally-aggressive vascular tumours and angiosarcomas. It is stressed that, although some of these lesions may display features suggestive of malignancy, care should be exercised when making this diagnosis, as in recent years there has been an increase in the recognition and characterization of benign vascular lesions which exhibit unusual features.

Clinical and histopathologic data were obtained on 353 cases of oral melanotic macules. The mean age at the time of diagnosis for all sites was 43.1 years. A significant predilection for females (p < 0.001) was noted and the most common location was the lower lip (33.0%). The mean size of the lesions was 6.8 mm. Brown was the most common color (64.9%), and most (66.0%) of the lesions were described as flat. Melanin was evident in both the basal cell layer and lamina propria in 93.5% of the cases.

The diagnosis of bacillary angiomatosis (BA) was performed on a biopsy of a reddish nodular lesion of the gingival mucosa, in a patient seropositive for the H.I.V. It was based on the histopathological features, and by the demonstration of bacilli both on the Warthin-Starry stain and the electron microscopic study. A treatment by erythromycin was quickly effective. BA is an opportunistic infection seen essentially in patients with A.I.D.S., most often causing cutaneous involvement. The causative pathogen is Rochalimaea henselae. BA of the oral cavity is very rare. This infection can be mistaken with Kaposi sarcoma on its clinical appearance.

Various tumorlike reactions of the oral mucous membranes under the term Epulis are summarized. These histologically different benign or malignant neoplasms of the gingiva are not very frequent. The differential diagnosis on a clinical basis like symptoms and macroscopic appearance is not easy. Sometimes under these harmless appearing lesions highly aggressive and malignant tumors may be hidden; as there are carcinomas, sarcomas, metastases, tumors of the salivary glands or malignant lymphomas. The therapy of choice is the complete removal including the underlaying periosteum. Occasionally the adjacent bone and tooth have also to be resected. Because of the harmless clinical appearance a histological examination is always required. Some clinical and pathohistological impressive examples are presented.