RESUMEN
Orofacial granulomatosis (OFG) is an uncommon condition with varying clinical presentation. Gingival enlargement in children could be due to a varied etiology. The present case report is of an adolescent female with initial presentation of generalized gingival enlargement, lip swelling and perioral discoloration without any known etiopathological factors or systemic involvement. Conservative excision of the enlargement was performed and histopathological examination revealed a non caseating granulomatous lesion. Diagnosis of orofacial granulomatosis in context to sarcoidosis was arrived after excluding other granulomatous diseases. Follow up after 18 months showed no recurrence and regression of lip swelling and perioral discoloration. Gingival enlargement can be considered as one of the presenting features of sarcoidosis.
Asunto(s)
Hipertrofia Gingival , Granulomatosis Orofacial , Sarcoidosis , Adolescente , Niño , Femenino , Humanos , Hipertrofia Gingival/etiología , Granulomatosis Orofacial/diagnóstico , Granulomatosis Orofacial/etiología , Granulomatosis Orofacial/patología , Sarcoidosis/complicacionesAsunto(s)
Esclerosis Tuberosa/diagnóstico , Adolescente , Adulto , Angiomiolipoma/diagnóstico por imagen , Angiomiolipoma/etiología , Femenino , Hipertrofia Gingival/etiología , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/etiología , Humanos , Hidrocefalia/etiología , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/etiología , Linfangioleiomiomatosis/diagnóstico por imagen , Linfangioleiomiomatosis/etiología , Madres , Atrofias Ópticas Hereditarias/etiología , Rabdomioma/diagnóstico por imagen , Rabdomioma/etiologíaAsunto(s)
Hiperplasia Gingival/diagnóstico , Hipertrofia Gingival/diagnóstico , Algoritmos , Fibromatosis Gingival/diagnóstico , Fibromatosis Gingival/etiología , Hiperplasia Gingival/etiología , Hipertrofia Gingival/etiología , Granuloma/diagnóstico , Granuloma/etiología , Granulomatosis Orofacial/diagnóstico , Granulomatosis Orofacial/etiología , HumanosRESUMEN
Urbach-Wiethe disease (lipoid proteinosis) is an autosomal recessive disorder that is characterized by a general thickening of the skin and mucous membranes. We report the case of a 22-year-old woman with lipoid proteinosis who presented with hoarseness, poor dentition, and skin lesions, and we discuss the management of this rare disease.
Asunto(s)
Proteinosis Lipoidea de Urbach y Wiethe/diagnóstico , Femenino , Hipertrofia Gingival/etiología , Ronquera/etiología , Humanos , Laringoscopía , Proteinosis Lipoidea de Urbach y Wiethe/complicaciones , Proteinosis Lipoidea de Urbach y Wiethe/patología , Úlceras Bucales/etiología , Pliegues Vocales/patología , Adulto JovenRESUMEN
Mucolipidosis type II (ML II, OMIM 252,500) is an autosomal recessive disorder clinically characterized by facial dysmorphia similar to Hurler syndrome and pronounced gingival hypertrophy. The disorder is caused by a defect in targeting acid hydrolases on the surface of lysosomes, which impede their entry and lead to accumulation of undigested substrates in lysosomes. The onset of the symptoms is usually in infancy, beginning in the 6th month of life. Early onset, at birth or even in utero, is a sign of severity and involves the specific dysmorphia as well as skeletal dysplasia related to hyperparathyroidism. We report on a severe neonatal form of this disorder revealed by respiratory distress with severe chest deformity. The dysmorphic syndrome, combining coarse features, pronounced gingival hypertrophy, with diffuse bone demineralization and secondary hyperparathyroidism associating significant elevation of parathyroid hormone and alkaline phosphatase with normal levels of vitamin D and calcium were characteristics of mucolipidosis type II. Recognizing this specific association of anomalies helps eliminate the differential diagnosis and establish appropriate diagnosis and care.
Asunto(s)
Mucolipidosis/diagnóstico , Fosfatasa Alcalina/sangre , Desmineralización Ósea Patológica/etiología , Hipertrofia Gingival/etiología , Humanos , Hiperparatiroidismo Secundario/etiología , Recién Nacido , Masculino , Hormona Paratiroidea/sangre , Índice de Severidad de la EnfermedadRESUMEN
Acute myeloid leukemias (AMLs) are aggressive hematopoietic neoplasms that, if untreated, can lead to death within days. Owing to its high morbidity rate, early diagnosis and appropriate medical therapy is essential. Oral lesions may be the presenting feature of acute leukemias and are, therefore, important diagnostic indicators of the disease. Erythematous or cyanotic gingival hyperplasia with or without necrosis is reported to be the most consistent symptom leading to a diagnosis of acute leukemia that directs the patient to seek early dental consultation. This report refers to a patient with AML that was provisionally diagnosed in the dental hospital due to severe gingival enlargements.
Asunto(s)
Encía/patología , Hipertrofia Gingival/diagnóstico , Leucemia Mieloide Aguda/diagnóstico , Adulto , Diagnóstico Diferencial , Hipertrofia Gingival/etiología , Humanos , Leucemia Mieloide Aguda/complicaciones , MasculinoRESUMEN
BACKGROUND: Human multipotent mesenchymal stromal cells (hMSCs) produce tumor necrosis factor (TNF)-α-stimulated protein 6 (TSG-6). TSG-6 modulates proinflammatory cytokine cascades and enhances tissue repair. This study tests the effects of recombinant human TSG-6 (rhTSG-6) on gingival wound healing within the first 2 days post-surgery. METHODS: After gingival resection in 120 Sprague-Dawley rats, 2 µg rhTSG-6 in 5-µL phosphate-buffered saline (PBS) or the same volume of only PBS solution was injected into gingival tissue approximating the surgical wound. Control animals did not receive injections. Tissue biopsies and blood were collected at 1 to 2, 6 to 8, 24, and 48 hours post-surgery (n = 10 per group). Specimens were analyzed via histologic analysis and enzyme-linked immunosorbent assay (ELISA) for quantification and comparison of inflammatory markers interleukin (IL)-1ß, IL-6, TNF-α, and myeloperoxidase (MPO). Wound photographs were taken for a double-masked clinical assessment at each time period. Weights were recorded for all animals pre- and post-surgery. RESULTS: Animals injected with rhTSG-6 had significantly less severe clinical inflammation at 6 to 8 (P = 0.01228), 24 (P = 0.01675), and 48 (P = 0.0186) hours. Sham and control animals had more weight loss at 24 and 48 hours. Sham and control animals had more pronounced cellular infiltrate. rhTSG-6-treated animals had significantly less MPO (P = 0.027) at 24 hours and IL-1ß (P = 0.027) at 24 and 48 hours. IL-6 showed a marginal significant difference at 6 to 8 hours, but there was no significant difference for TNF-α. CONCLUSION: rhTSG-6 reduced postoperative gingival inflammation by reducing levels of proinflammatory cytokines and cellular infiltrate and may offer significant promise as an anti-inflammatory agent for gingival surgery.
Asunto(s)
Moléculas de Adhesión Celular/uso terapéutico , Encía/efectos de los fármacos , Gingivectomía/métodos , Factor de Necrosis Tumoral alfa/uso terapéutico , Animales , Antiinflamatorios/uso terapéutico , Peso Corporal , Moléculas de Adhesión Celular/análisis , Eritema/etiología , Eritema/metabolismo , Encía/química , Enfermedades de las Encías/etiología , Enfermedades de las Encías/metabolismo , Hemorragia Gingival/etiología , Hemorragia Gingival/metabolismo , Hipertrofia Gingival/etiología , Hipertrofia Gingival/metabolismo , Gingivitis/etiología , Gingivitis/metabolismo , Humanos , Mediadores de Inflamación/análisis , Interleucina-1beta/análisis , Interleucina-1beta/efectos de los fármacos , Interleucina-6/análisis , Masculino , Peroxidasa/análisis , Peroxidasa/efectos de los fármacos , Ratas , Ratas Sprague-Dawley , Proteínas Recombinantes , Factores de Tiempo , Factor de Necrosis Tumoral alfa/análisis , Cicatrización de Heridas/efectos de los fármacosRESUMEN
Juvenile hyaline fibromatosis is a rare, hereditary disease with distinct clinical and histopathological features. Clinically, it presents with gingival hypertrophy, pappulonodular skin lesions and joint contractures. Bone involvement is usually an uncommon finding. We report a case of a 2-year-old patient, daughter of consanguineous parents, who presented since the age of 2 months with impairment of mental development, multiple joint contractures, motion limitation and nodules on the scalp. The calvarian lesions were surgically removed, and histopathological examination concluded to juvenile hyaline fibromatosis.
Asunto(s)
Hialina/metabolismo , Síndrome de Fibromatosis Hialina/diagnóstico , Biomarcadores/metabolismo , Biopsia , Encéfalo/metabolismo , Encéfalo/patología , Preescolar , Contractura/diagnóstico , Contractura/etiología , Contractura/metabolismo , Femenino , Hipertrofia Gingival/diagnóstico , Hipertrofia Gingival/etiología , Hipertrofia Gingival/metabolismo , Humanos , Síndrome de Fibromatosis Hialina/complicaciones , Síndrome de Fibromatosis Hialina/metabolismo , Síndrome de Fibromatosis Hialina/patología , Síndrome de Fibromatosis Hialina/cirugía , Imagen por Resonancia Magnética , Valor Predictivo de las Pruebas , Piel/metabolismo , Piel/patologíaRESUMEN
INTRODUCTION: Gingival enlargement is a common form of periodontal tissue reaction to several irritating factors. The most common form is the drug related gingival hyperplasia--nevertheless the heredity gingival fibromatosis and hematological cases can also occur and might impose a challenge to periodontists. After a short literature summary three Case reports are presented. The first case is a drug related gingival overgrowth in a young kidney transplant women who took Cyclosporin-A. The excessive mass of fibrotic tissue was removed by a series of internal beveled incision and the oral and buccal gingival flaps were united with sutures. The healing was uneventful and during the follow up patient's compliance and oral hygiene was superb. The second case is a very severe antihypertensive drug related gingival overgrowth in a 62 years old man interfering with the closure of his lip and corrected with a combination of conventional gingivectomy and internal reverse beveled incision both and Ca-channel blockers. The third case is a 42 years old woman with chronic idiopathic hemolytic anemia who presented a sudden onset acute excessive generalized gingival enlargement accompanied with severe pain and fever. At admission she was suspect for leukemia. After obtaining biopsy samples and having negative histology the soft tissue mass was removed under general anesthesia with conventional gingivectomy technique, but after a couple of days the severe pain and gingival swelling recurred. With administering systemic corticosteroid therapy (32 mg Medrol), the gingiva healed in five days and the one year follow-up showed a stable hematological and periodontal status. Today the more conservative internal beveled incision is preferred over the conventional gingivectomy in the most cases because it provides a more predictable healing and better esthetics. The recurrence of the drug related gingival hyperplasia can be anticipated by meticulous postoperative individual oral hygiene and regular supportive therapy. CONCLUSION: The combined conservative and surgical therapy leads to predictable postoperative result even in very severe systematically motivated gingival enlargements, nevertheless the successful patients management needs good cooperation with medical doctors and with the patients themselves.
Asunto(s)
Hiperplasia Gingival/etiología , Hiperplasia Gingival/cirugía , Hipertrofia Gingival/etiología , Hipertrofia Gingival/cirugía , Gingivectomía , Adulto , Anciano , Anemia Hemolítica/complicaciones , Antihipertensivos/administración & dosificación , Antihipertensivos/efectos adversos , Bloqueadores de los Canales de Calcio/administración & dosificación , Bloqueadores de los Canales de Calcio/efectos adversos , Ciclosporina/administración & dosificación , Ciclosporina/efectos adversos , Femenino , Fiebre/etiología , Hiperplasia Gingival/inducido químicamente , Hiperplasia Gingival/complicaciones , Hipertrofia Gingival/inducido químicamente , Hipertrofia Gingival/complicaciones , Gingivectomía/métodos , Granuloma/complicaciones , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/efectos adversos , Trasplante de Riñón , Masculino , Persona de Mediana Edad , Higiene Bucal , Dolor/etiología , Supuración , Resultado del TratamientoRESUMEN
INTRODUCTION: Cowden syndrome is rare; oral symptoms are not always diagnosed. This case of Cowden syndrome was revealed by gingival hypertrophy. OBSERVATION: A 21-year-old female patient consulted for gingival hypertrophy and multiple papules in the mouth. She had a history of thyroid lobectomy due to a goiter. The gingival papillomatosis and the goiter suggested a Cowden syndrome. The diagnosis was confirmed clinically by facial skin papules. DISCUSSION: Cutaneous and oral lesions are usually the first symptoms of the syndrome. Diffuse gingival papillomatosis may suggest a Cowden syndrome and should lead to screen for associated symptoms. A high-risk diagnosis of breast and thyroid cancer is associated to Cowden syndrome and the patient should have a yearly follow-up.
Asunto(s)
Hipertrofia Gingival/diagnóstico , Síndrome de Hamartoma Múltiple/diagnóstico , Ciego , Femenino , Hipertrofia Gingival/etiología , Síndrome de Hamartoma Múltiple/complicaciones , Humanos , Pólipos Intestinales/diagnóstico , Pólipos Intestinales/etiología , Adulto JovenAsunto(s)
Artritis/diagnóstico por imagen , Hipertrofia Gingival/diagnóstico , Articulación de la Rodilla/diagnóstico por imagen , Escorbuto/diagnóstico , Ácido Ascórbico/administración & dosificación , Ácido Ascórbico/sangre , Trastorno Autístico/complicaciones , Calcinosis/diagnóstico por imagen , Calcinosis/etiología , Calcinosis/patología , Niño , Hipertrofia Gingival/etiología , Hipertrofia Gingival/patología , Humanos , Articulación de la Rodilla/patología , Masculino , Radiografía , Escorbuto/tratamiento farmacológicoRESUMEN
Oral cavity reflects the health status of an individual. Many systemic diseases have signs and symptoms that manifest in the oral cavity, which in most of the cases precede the systemic manifestations. These array of diseases also include acute leukemias which present as gingival hyperplasia as the most consistent symptom seeking dental consultation that can be easily confused with many other benign conditions that present as gingival enlargements. One such rare case of adult acute lymphoblastic leukemia is presented in this article.
Asunto(s)
Hipertrofia Gingival/etiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Biomarcadores de Tumor/análisis , Biopsia , Médula Ósea/patología , Diagnóstico Diferencial , Resultado Fatal , Femenino , Hipertrofia Gingival/patología , Humanos , Leiomioma/diagnóstico , Persona de Mediana Edad , Neoplasias Primarias Múltiples/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/patología , Negativa del Paciente al Tratamiento , Neoplasias Uterinas/diagnóstico , Pérdida de PesoRESUMEN
BACKGROUND: Infantile systemic hyalinosis is a rare genetic disorder which involves accumulation of hyaline in the skin, bones, mucous membranes, and occasionally, also in internal organs. The major manifestations include painful articular contractures, cutaneous lesions (hyperpigmentation, subcutaneous nodules), malnutrition resulting from diarrhoea, gingival, labial and buccal hypertrophy. CASE REPORT: The phenotype characteristics of infantile systemic hyalinosis (ISH) in a two year old boy were present. The characteristics of flattered occiput, limited limb movements and articular abnormalities of elbows and knees. Dental findings showed excessive gingival hypertrophy completely covering maxillary and mandibular teeth treatment. The gingival hypertrophy was surgically treated by gingivectomy under general anaesthesia. FOLLOWUP: The patient showed a full constellation of clinical manifestations of the disease. Despite the surgical intervention no improvement in oral hygiene was observed. CONCLUSIONS: Surgical treatment of the gingival hypertrophy was the treatment of choice.
Asunto(s)
Hipertrofia Gingival/etiología , Hipertrofia Gingival/cirugía , Síndrome de Fibromatosis Hialina/complicaciones , Preescolar , Gingivectomía , Humanos , Masculino , Higiene Bucal/educaciónRESUMEN
INTRODUCTION: In this study, we aim to compare the levels of matrix metalloproteinase 9 (MMP9) in the gingival crevicular fluid (GCF), as indicators for healing, in two groups of patients - operated with a classic periodontal surgical technique and the same technique but using a dental microscope. MATERIALS: We included 14 patients with ages between 12 and 26 years, average 14±6.2 years. Eight patients were women and six men. All patients presented gingival hypertrophy because of the orthodontic treatment on the mandibular arch. We performed gingivectomy on one-half of the mandibular arch by classic periodontal surgery and on the other half of the mandibular arch by a microscope-assisted gingivectomy. METHODS: In the hypertrophied gingiva, the expression of MMP9 was identified using immunohistochemical-staining techniques. For immunological determination of MMP9 in GCF we performed Elisa tests. RESULTS: We found different levels in different moments of the healing process for the two hemiarcades. CONCLUSIONS: We consider that faster healing in case of microscope-assisted gingivectomy may be related to the expression of MMP-9 in the GCF.
Asunto(s)
Líquido del Surco Gingival/enzimología , Hipertrofia Gingival/etiología , Hipertrofia Gingival/cirugía , Metaloproteinasa 9 de la Matriz/metabolismo , Microcirugia , Aparatos Ortodóncicos/efectos adversos , Periodoncio/cirugía , Adolescente , Adulto , Niño , Femenino , Hipertrofia Gingival/enzimología , Hipertrofia Gingival/patología , Humanos , Masculino , Adulto JovenRESUMEN
A 66-year-old female presented with gum bleeding and soreness. Her medical history was significant for delayed wound healing, which appeared to cause blindness in her right eye. A gingival incisional biopsy revealed replacement of fibrous connective tissue by an amorphous and eosinophilic material. Direct immunofluorescent staining for antibodies was negative. After the differential diagnosis of ligneous gingivitis (LG) was rendered, the activity and antigenic level of plasminogen was tested and found to be significantly decreased. Partial improvement was observed within 1 year following a regimen of scaling, gingival curettage, topical steroids, and improved oral hygiene. LG is a rare condition, occurring as a result of plasminogen deficiency and subsequent fibrin accumulation. It presents as pseudomembranous gingiva and might affect the eyes and other organs. Dentists should be familiar with this condition, since they might assist in a diagnosis of this disease, with significant morbidity often missed by medical professionals.
Asunto(s)
Gingivitis/etiología , Plasminógeno/deficiencia , Anciano , Antiinflamatorios/uso terapéutico , Raspado Dental/métodos , Dexametasona/uso terapéutico , Diagnóstico Diferencial , Eosinófilos/patología , Femenino , Técnica del Anticuerpo Fluorescente Directa , Estudios de Seguimiento , Hemorragia Gingival/etiología , Hipertrofia Gingival/etiología , Gingivitis/patología , Glucocorticoides/uso terapéutico , Humanos , Higiene Bucal , Curetaje Subgingival/métodosRESUMEN
BACKGROUND: Leukemia is a fatal disease. The oral manifestations of the leukemias occur early in the course of the disease and these oral features can at times act as a diagnostic indicator. Saliva has been used as a diagnostic aid in a number of systemic diseases. MATERIALS AND METHODS: In our study, samples of unstimulated saliva of 30 leukemia patients who were not on chemotherapy were collected and analyzed for salivary amylase and total protein. The oral manifestations and radiographic changes (OPG) were recorded. The correlation between the oral manifestations and the salivary components (salivary amylase and total protein) was assessed for prognostic significance. RESULTS: In the present study when the mean values of salivary amylase (1280±754 U/ml) and total protein (647.2±320.7 mg%) were compared with that in control subjects. There was a statistically significant difference for amylase levels (P<.05). On intraoral examination the study subjects showed pallor, gingivitis, gingival enlargement, petechiae, and ecchymosis. On the OPG, the radiographic features included generalized rarefaction of bone (20%), thinning of lamina dura (3.4%), generalized alveolar crest bone resorption (30%), thinning of walls of alveolar crypts (6.7%), besides others, e.g., periapical abscess (10%). CONCLUSIONS: The saliva of leukemic patients demonstrated obvious changes in composition. A rise in salivary amylase and total protein levels was evident, with the increase in amylase levels being statistically significant.
Asunto(s)
Amilasas/análisis , Enfermedades Maxilomandibulares/diagnóstico por imagen , Leucemia/metabolismo , Saliva/enzimología , Proteínas y Péptidos Salivales/análisis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/etiología , Estudios de Casos y Controles , Niño , Preescolar , Equimosis/etiología , Femenino , Hipertrofia Gingival/etiología , Gingivitis/etiología , Humanos , Enfermedades Maxilomandibulares/etiología , Leucemia/complicaciones , Leucemia Linfocítica Crónica de Células B/complicaciones , Leucemia Linfocítica Crónica de Células B/metabolismo , Leucemia Mielógena Crónica BCR-ABL Positiva/complicaciones , Leucemia Mielógena Crónica BCR-ABL Positiva/metabolismo , Leucemia Mieloide Aguda/complicaciones , Leucemia Mieloide Aguda/metabolismo , Masculino , Persona de Mediana Edad , Enfermedades de la Boca/etiología , Absceso Periapical/diagnóstico por imagen , Absceso Periapical/etiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/metabolismo , Púrpura/etiología , Radiografía Panorámica , Adulto JovenRESUMEN
Leukemia is a hematological disorder arises from a hematopoietic stem cell characterized by a disordered differentiation and proliferation of neoplastic cells. Rapidly forming generalized gingival hyperplasia is usually the first sign of this disease (especially in acute forms). This case report describes a 54-year-old female who presented rapid gingival enlargement in only three weeks time, heralding the presence of acute monocytic leukemia (AML-FAB M5). The patient was immediately referred for hematologic management, but died five weeks later. Dentists and generalists should always be on guard to observe any oral manifestations that may lead to the early diagnostic of systemic diseases.