Enfermedades gingivales en niños y adolescentes: primera parte / Gingival diseases in children and adolescents: first part

Las características de los tejidos gingivales y periodontales son diferentes en niños y adolescentes. La clasificación actual de enfermedades gingivales incluye a las gingivitis producidas por el biofilm y a las no producidas por el biofilm de placa. Las gingivitis son reversibles. Las condiciones de riesgo individuales, de origen externo o de origen sistémico, influyen en el agravamiento. La prevención de la gingivitis está enfocada en el control de los factores de riesgo.

Gummy Smile and Short Tooth Syndrome--Part 1: Etiopathogenesis, Classification, and Diagnostic Guidelines.

Treating patients with "gummy smiles" and improving smile esthetics has become an integral part of dentistry. It is necessary to conduct an accurate diagnosis of what may be multiple causes that coexist simultaneously. Though all causes may not be resolved following treatment, they should be identified; otherwise it might not be possible to conduct an adequate order of treatment, which could involve multidisciplinary collaboration between various dental specialists, and may lead to unexpected and unacceptable final results. The authors propose a complete adult classification of the causes identified for gummy smile (GS) and short tooth syndrome (STS) to ascertain the etiopathogenetic origin(s). Used in combination with the proposed diagnostic procedure, which involves an "outside-in" evaluation of the patient, the classification system will enable clinicians to provide patients an accurate prediction of final results and determine the treatment required.

Influence of Environmental Tobacco Smoke on Gingival Pigmentation in Schoolchildren.

PURPOSE: To examine the relationship between environmental tobacco smoke (ETS) and oral pigmentation in schoolchildren. MATERIALS AND METHODS: Oral photographs of 117 systemically healthy, nonsmoking children and young adults (aged 10 to 21 years) were randomly selected from two rural schools. Closed-ended questionnaires were designed for this age group and used to record answers given by the subjects. The subjects were divided into two groups based on age: group 1 (10 to 14 years) and group 2 (15 to 21 years). There were 58 subjects in group 1 and 59 in group 2. Gingival pigmentation was classified using the Melanin Index Score (MIS) into MIS-0 (no pigmentation), MIS-1 (solitary unit(s) of pigmentation in papillary gingiva) and MIS-2 (continuous band extending from 2 neighbouring solitary units). RESULTS: In group 1, 17.24% of subjects displayed MIS-0 compared to only 5.08% in group 2. The difference between the groups was found to be statistically significant according to Student's t-test (p < 0.001). In group 2, 38.98% of subjects showed MIS-2 as compared to only 17.24% subjects in group 1. CONCLUSION: Despite the relatively small sample size, the results of the present study confirmed previously reported findings that ETS has an influence on both the prevalence and the severity of gingival pigmentation.

Presencia de factores sistémicos en los distintos estados periodontales / The presence of systemic factors in the different periodontal conditions

Se escribe sobre la importancia de la infección que representa la enfermedad periodontal como iniciación o agravamiento de las alteraciones en losdistintos sistémas que conforman nuestro organismo, como también a la inversa las enfermedades sistémicas pueden facilitar la acción de la placa bacteriana al disminuir las defensas de los tejidos de soporte. El objetivo de éste trabajo es conocer la existencia de éstos factores sistémicos en cada unode los grados de evolución de la enfermedad gingivoperiodontal

Frictional keratoses on the facial attached gingiva are rare clinical findings and do not belong to the category of leukoplakia.

PURPOSE: To investigate the clinical and histologic features of frictional keratoses located exclusively on the facial attached gingiva and establish whether these belong to the category of leukoplakia. MATERIALS AND METHODS: Over a period of 15 years, 159 patients presenting with oral keratotic plaques, located exclusively on the facial attached gingival mucosa, excluding the edentulous alveolar ridge and retromolar pad area, were retrospectively selected. Clinical and histologic features and the symptoms and progression of these lesions were carefully assessed. RESULTS: The presence of oral frictional keratosis located exclusively on the facial attached gingival mucosa was clinically and immunohistologically diagnosed in 14 of 159 patients (8.8%). Eleven patients (78.5%) showed unilateral involvement, whereas 3 patients (21.5%) had bilateral involvement. The disappearance of the lesions was accomplished in only 9 of 14 patients, resulting from discontinuation of bad habits. Clinically, these lesions appeared as distinct, sharply demarcated, isolated, asymptomatic, homogeneous whitish-plaques that were neither removable nor painful. The plaques did not create discomfort, change shape, or develop into malignancy. Histologically, these plaques showed features superimposable to those present in benign alveolar ridge keratoses. CONCLUSION: The results highlighted that frictional keratoses on the facial attached gingival mucosa 1) are rare findings, 2) clinically appear as "true leukoplakia" but histologically have the same features as benign alveolar ridge keratoses, 3) have no propensity for malignant transformation, 4) have a good prognosis, and 5) have a specific cause, and resolution is accomplished if the frictional element is eliminated. Thus, these must be removed from the category of leukoplakia.

Effect of environmental tobacco smoke from smoker parents on gingival pigmentation in children and young adults: a cross-sectional study.

BACKGROUND: Non-smokers exposed to environmental tobacco smoke (ETS) absorb nicotine and other compounds just as smokers do, and as the exposure to ETS increases, the level of these harmful compounds in the body also increases. The ill effects of ETS range from gingival pigmentation to lung cancer and death. The exposure to ETS is difficult to quantitatively measure and has been approximated by self-reported estimates, primarily of the smoking history of spouses. However, the documentation of gingival pigmentation in non-smokers is meager and has remained contentious. We aimed to assess the effects of ETS from smoker parents on gingival pigmentation in children and young adults and assess the urine cotinine levels in these individuals. METHODS: A total of 153 non-smoking participants with ≥1 smoker parent were randomly selected from the outpatient Department of Periodontics, Bangalore Institute of Dental Sciences and Postgraduate Research Center, Bangalore, India. These participants were divided into three groups based on age, and the smoking history of parents was established by an interview with participants and parents. The degree of gingival pigmentation of participants was assessed by using the gingival pigmentation index and a standardized digital oral photograph. A urine analysis was conducted to assess levels of cotinine. The κ statistic was performed for interexaminer agreement, and χ(2) and Fisher exact tests were used for statistical analyses. RESULTS: The prevalence of gingival pigmentation in passive smokers was statistically significant (P <0.05). Increased levels of urinary cotinine were observed in all three groups with the highest levels in group 3 (19 to 24 years old). CONCLUSION: This study depicts the effects of ETS on gingival melanin pigmentation.

LPS induces greater bone and PDL loss in SPARC-null mice.

Individuals with periodontal disease have increased risk of tooth loss, particularly in cases with associated loss of alveolar bone and periodontal ligament (PDL). Current treatments do not predictably regenerate damaged PDL. Collagen I is the primary component of bone and PDL extracellular matrix. SPARC/Osteonectin (SP/ON) is implicated in the regulation of collagen content in healthy PDL. In this study, periodontal disease was induced by injections of lipopolysaccharide (LPS) from Aggregatibacter actinomycetemcomitans in wild-type (WT) and SP/ON-null C57/Bl6 mice. A 20-µg quantity of LPS was injected between the first and second molars 3 times a week for 4 weeks, whereas PBS control was injected into the contralateral maxilla. LPS injection resulted in a significant decrease in bone volume fraction in both genotypes; however, significantly greater bone loss was detected in SP/ON-null maxilla. SP/ON-null PDL exhibited more extensive degradation of connective tissue in the gingival tissues. Although total cell numbers in the PDL of SP/ON-null were not different from those in WT, the inflammatory infiltrate was reduced in SP/ON-null PDL. Histology of collagen fibers revealed marked reductions in collagen volume fraction and in thick collagen volume fraction in the PDL of SP/ON-null mice. SP/ON protects collagen content in PDL and in alveolar bone in experimental periodontal disease.

Periodontal and gingival parameters in young adults with acute myeloid leukaemia in Kerala, South India.

PURPOSE: Patients presenting with leukaemic blast crisis with acute myeloid leukaemia (AML) may have gingival enlargements that interfere with oral hygiene. Few large cohort studies of gingival lesions have been carried out on AML patients. The aim of the present study was to assess gingival and periodontal pathology at the time of presentation, prior to chemotherapy, in a cohort of adult patients presenting at a cancer hospital in Kerala, a region located in southern India. MATERIALS AND METHODS: A total of 73 young adult patients (mean age 20.6 ± 2.3) who were diagnosed with AML were examined. These patients did not suffer from any other systemic disorder. The oral hygiene status, gingival overgrowth (GO) and periodontal status were assessed using traditional clinical indices. RESULTS: Around three-quarters of the patients had either fair or poor oral hygiene. A statistically significant association between dental plaque levels and both GO and periodontal index (P < 0.001) was observed. CONCLUSIONS: Poor oral hygiene is a risk factor for leukaemic GO and for destructive periodontal disease. Both conditions add to the microbial burden these patients are exposed to. In patients showing high levels of oral hygiene, the GO tends to be mild and does not seem to be problematic, especially with respect to mechanical tooth cleaning.

Pediatric localized reactive gingival lesions: a retrospective study from Israel.

PURPOSE: Chronic irritation of the gingiva causes localized reactive hyperplastic lesions (LRHLs), which are classified into: peripheral ossifying fibroma (POF); peripheral giant cell granuloma (PGCG); pyogenic granuloma (PG); and focal fibrous hyperplasia (FFH). The purpose of this study was to determine the frequency of localized reactive hyperplastic lesions in Israeli children and adolescents. METHODS: All consecutive archival LRHL biopsies of the gingiva between 1989 and 2008 were included. Lesions were analyzed according to location and patients' age and gender. Our findings were compared to pediatric and all-age data in publications from other countries. RESULTS: Of 233 gingival LRHL specimens, POFs were most common (33%), followed by PGs (25%), FFHs (23%) and PGCGs (20%). PGs and FFHs were more common in females, and PGCG were more common in males. POFs showed no gender predilection. PGCGs and FFHs were distributed almost equally between the maxilla and mandible, while POFs and PGs were more common in the maxilla. Comparing data to other countries was problematic because there were so few dedicated to the pediatric population and because of inconsistencies in data presentation. CONCLUSIONS: Pediatric dentists should be aware of gingival LRHLs, because they are not uncommon among children.

Penfigoide benigno de las mucosas: reporte de caso clínico / Benign pemphigoid of the oral mucosa: report of a clinical case

El penfigoide benigno de las mucosas es una enfermedad autoinmune ampollar. En un 80 por ciento de los casos está afectada la mucosa oral, de ahí la importancia que dicha enfermedad la conozca el odontólogo general y el especialista. El siguiente caso muestra el compromiso de la mucosa gingival en una paciente de 12 años de edad.

Association of lip pigmentation with smoking and gingival melanin pigmentation.

OBJECTIVE: We investigated the association of lip pigmentation with smoking and melanin pigmentation in the gingiva. DESIGN: Case-control study. SETTING: Health check-up in an institute. SUBJECTS AND METHODS: Photos of 213 males employed in an institution were assessed in terms of pigmentation in lip and gingiva. MAIN OUTCOME MEASURES: Prevalence and scores of lip and gingival pigmentation and smoking status. RESULTS: Among subjects displaying lip and gingival pigmentation, 73% and 87% respectively, were current smokers, whereas 33% and 27% of individuals lacking pigmentation were current smokers respectively. Odds ratios of current smoking relative to lip and gingival pigmentation were 5.6 (95% confidence interval: 2.8-11.1) and 17.0 (8.1-36.0) respectively. Daily consumption, duration of smoking and lifetime exposure exhibited significant correlation with scores of lip and gingival pigmentation (P<0.0001). Odds ratios increased in lip and gingival pigmentation upon exposure. In current smokers, scores of lip and gingival pigmentation demonstrated meaningful correlation (P<0.0001); moreover, 95% of participants with lip pigmentation were positive for gingival pigmentation. CONCLUSION: These results indicated the presence of a striking association between smoking and pigmentation in the lip and gingiva, which was stronger with respect to gingival pigmentation. Health professionals could educate smokers, utilizing visible symptoms in the lip and gingiva.

Peripheral odontogenic tumor: a clinicopathologic study of 30 cases. General features and hamartomatous lesions.

BACKGROUND: Peripheral odontogenic tumors (POT), either neoplastic or hamartomatous, are rare. This study briefly summarizes the general features of POT and selectively reviews the histomorphologic spectrum of under-recognized hamartomatous lesions that we have designated peripheral odontogenic hamartomas (POH) in order to shed more light into the pathogenesis of POT. METHODS: Archival material accessioned at our institutions between 1970 and 2004 was systematically searched to identify examples of POT/POH. RESULTS: Among 39 660 biopsies, we retrieved 25 cases of 'classical' POT and five cases of 'unique' POH. Odontogenic fibroma and ameloblastoma were by far the most common. Of POH, two purely epithelial lesions showed multiple strands of basaloid rests [odontogenic gingival epithelial hamartoma (OGEH)] and a conglomerate of polyhedral epithelium, ghost cells and concentric calcifications (calcifying epithelial odontogenic tumor-like hamartoma), respectively. OGEH and peripheral squamous odontogenic tumor (PSOT) deserve to be a related entity. In two types of mixed POH, ectomesenchymal elements appeared juxtaposed to the squamous lining (gingival cyst-like organoid hamartoma) and ghost cells aggregated in the enamel organ of a microdont (peripheral odontoma). None of POH exhibited continuity with the surface epithelium. CONCLUSION: On the basis of this relatively limited series of cases, POH, to conceptualize a unified histogenetic source, are speculated to arise from the soft-tissue remnants of dental lamina. Gingival rests of Serres seem to retain the ability to pursue epithelial-ectomesenchymal interactions that are necessary leading to odontoma formation.

Oral lichen planus: a clinical and morphometric study of oral lesions in relation to clinical presentation.

Oral lichen planus (OLP) is a chronic inflammatory disease with different clinical presentations that can be classified as reticular or atrophic-erosive. Sixty-two OLP patients were studied to evaluate the clinical-pathologic characteristics of their OLP lesions and to investigate possible differences in their biological behavior. The most common clinical presentation was the reticular type (62.9% vs 37.1%). Atrophic-erosive presentations showed significantly longer evolution (chi square=4.454; p=0.049), more extensive lesions (chi square=16.211; p=0.000) and more sites affected than reticular ones (chi square=10.048; p=0.002). Atrophic-erosive OLP was more frequently found on the tongue, gingiva and floor of the mouth. No statistically significant differences could be identified between reticular and atrophic-erosive clinical presentations in terms of age, sex, tobacco habit, plasma cortisol level and depth of inflammatory infiltrate. We concluded that the classification of OLP lesions as reticular vs atrophic-erosive is a simple, easy to use classification that can identify clinical presentations with different biological behavior.

Granuloma gingantocelular periférico: presentación de dos casos / Peripheral giant cell granuloma: report of two cases

Se estudiaron dos casos de granulomas periféricos de células gigantes, de gran tamaño, en adulto de 30 años y 50 años, comparando las características clínicas, radiográficas e histopatológicas; en este último aspecto se realizó inmunohistoquímica, utlizando el anticuerpo monoclonal MIB-1 (Ki 67 en parafina), el cual resultó de bajo índice de proliferacion celular, a pesar de no tener uno de los casos antecedente de recidiva, con un comportamiento agresivo.

Granuloma piogénico de gran tamaño en paciente embarazada: presentación de un caso / Large-sized pyogenic granuloma in pregnant patient: report of a case

El granuloma piogénico (GP) es una lesión reactiva común que se caracteriza por la proliferación excesiva del tejido conjuntivo como respuesta a una agresión, puede desarrollarse tanto en piel como en mucosas, siendo la última la más afectada. Se localiza a menudo en el tejido gingival, actuando los irritantes locales tipo cálculo o la placa dental como factor etiológico. Se puede presentar como una patología papular o tumoral, de coloración entre rosa pálido y rojo brillante; cuando cambios hormonales se presentan en el paciente, la lesión puede desarrollar un tamaño considerable y ser confundida con una neoplasia maligna. Es por esto que hacemos referencia a un caso de GP de tamaño inusual en una paciente embarazada, y una revisión de la literatura.