Un caso singular de granuloma de cèlulas plasmáticas y actinomicosis en encía / A singular case of plasma cell granuloma and actinomycosis in the gum

Antecedentes: El granuloma de cèlulas plasmáticas (GCP) es una patología poco común que se caracteriza por una lesión roja e hiperplasia que presenta una gran afinidad a cualquier tejido blando con mayor frecuencia a nivel pulmonar y de manera poco usual a nivel oral como los labios, lengua y encía como un caso muy singular, histológicamente se caracteriza por un gran número de cèlulas plasmáticas. Objetivo: Reportar un caso poco común de GCP en encía con el abordaje, complicaciones y èxito del tratamiento del mismo. Descripción del caso: paciente femenino de 60 años de edad, acude a consulta por una lesión roja nivel de la encía marginal y adherida del maxilar superior. Al examen intraoral se observa una hiperplasia localizada Con diagnostico presuntivo de granuloma de cèlulas plasmáticas, donde se le realizaron exámenes radiográficos, posteriormente una biopsia, confirmando dicho diagnóstico. Conclusión: GCP se caracteriza clínicamente por presentar una hipertrofia gingival en la encía adherida, una de los lugares menos frecuentes a nivel oral. Esta patología al presentar ciertas similitudes clínica e histológicamente es muy difícil realizar un correcto diagnóstico de dicha patología (AU)

Background: Plasma cell granuloma (PCG) is an uncommon pathology characterized by a red lesion and hyperplasia that has a high affinity to any soft tissue, more frequently at the lung level and in an unusual way at the oral level such as lips, tongue and gingiva as a very unique case, histologically characterized by a large number of plasma cells. Objective: To report a rare case of GCP in the gingiva with the approach, complications and success of its treatment. Description of the case: a 60-year-old female patient comes to the clinic for a red lesion at the level of the marginal and attached gingiva of the upper jaw. Intraoral examination revealed localized hyperplasia with a presumptive diagnosis of plasma cell granuloma, where radiographic examinations were performed, followed by a biopsy, confirming said diagnosis. Conclusion: GCP is clinically characterized by presenting gingival hypertrophy in the attached gingiva, one of the least frequent places at the oral level. This pathology, as it presents certain clinical and histological similarities, is very difficult to make a correct diagnosis of said pathology. (AU)

3D surface defect map for characterising the buccolingual profile of peri-implant tissues.

PURPOSE: To describe a novel, noninvasive, intraoral optical scanning-based approach for characterising the buccolingual profile of peri-implant tissues using a 3D surface defect map. MATERIALS AND METHODS: Intraoral optical scans of 20 isolated dental implants with peri-implant soft tissue dehiscence in 20 subjects were captured. The digital models were then imported into image analysis software, where an examiner (LM) performed a 3D surface defect map analysis characterising the buccolingual profile of the peri-implant tissues in respect to the adjacent teeth. Ten linear divergence points that were 0.5 mm apart in a corono-apical direction were identified at the midfacial aspect of the implants. Based on these points, the implants were grouped into three different buccolingual profiles. RESULTS: The method for creating the 3D surface defect map of isolated implant sites was outlined. Eight implants displayed pattern 1 (coronal profile of peri-implant tissues more lingual/palatal than their apical portion), six implants exhibited pattern 2 (opposite of pattern 1) and six sites showed pattern 3 (relatively uniform and "flat"). CONCLUSIONS: A novel method for assessing the buccolingual profile/position of peri-implant tissues using a single intraoral digital impression was proposed. The 3D surface defect map visualises the volumetric differences in the region of interest compared to the adjacent sites, allowing for objective quantification and reporting of profile/ridge deficiencies of isolated sites.

[Sterilization in dentistry. Limitations of elastic materials: a case presentation]. / Sterilizálási lehetoségek a fogászatban. Rugalmas anyagok csírátlanításának korlátai egy eset kapcsán.

In everyday dental practice, sterility is essential. Sterilizing different materials can require different methods. In the case of heat sensitive and elastic materials, most common techniques are not suitable because they need to be treated on lower temperature, not to lose their physical properties. For instance, if rubber dam is divested of elasticity, it is useless in restorative dentistry thereafter. Sterilizing rubber dam sheets is not a frequent process, but in certain cases it can be necessary. In such a situation, dentists have to choose between rare and hard-to-reach options. In our referral, we summarize the possibilities of sterilization, focusing on plasma sterilization and hydrogen-peroxide vapor sterilization. During the treatment of our presented case with a deep subgingival fracture line, affecting the crown and the root surface as well, we applied a rubber dam sheet, sterilized with hydrogen-peroxide vapor in order to use adhesive technique. Orv Hetil. 2020; 161(3): 110-115.

Adipose-derived stem cells prevent the onset of bisphosphonate-related osteonecrosis of the jaw through transforming growth factor ß-1-mediated gingival wound healing.

BACKGROUND: Due to its complex pathogenesis and low clinical cure rate, bisphosphonate-related osteonecrosis of the jaw (BRONJ) poses a substantial challenge for oral and maxillofacial surgeons. Therefore, the treatment of BRONJ should focus on prevention. In clinical studies, primary wound closure can significantly reduce the incidence of BRONJ. Whether local stem cell transplantation can promote primary gingival healing in patients with a medication history and prevent BRONJ has not been reported. METHODS: In this study, animals were divided into a healthy group (non-drug treatment), a BP group, a hydroxyapatite (HA) group, and an adipose-derived stem cell (ADSC) group. All groups except the healthy group were treated with BPs and immunosuppressive drugs once per week for 8 weeks, simulating clinical use for the treatment of cancer patients with bone metastasis, to induce BRONJ-like animals. After the sixth drug treatment, the bilateral premolars were extracted in all groups. In contrast to the healthy and BP groups, the extraction sockets in the HA and ADSC groups were filled with HA or HA + ADSCs simultaneously post extraction to observe the preventive effect of ADSCs on the occurrence of BRONJ. At 2 and 8 weeks post extraction, animals from all groups were sacrificed. RESULTS: At 8 weeks post transplantation, ADSCs prevented the occurrence of BRONJ, mainly through accelerating healing of the gingival epithelium at 2 weeks post extraction. We also found that ADSCs could upregulate the expression of transforming growth factor ß1 (TGF-ß1) and fibronectin in tissue from animals with a medication history by accelerating gingival healing of the extraction socket. A rescue assay further demonstrated that TGF-ß1 and fibronectin expression decreased in TGF-ß1-deficient ADSC-treated animals, which partially abolished the preventive effect of ADSCs on the onset of BRONJ. CONCLUSION: ADSCs prevent the onset of BRONJ, mainly by upregulating the expression of TGF-ß1 and fibronectin to promote primary gingival healing, ultimately leading to bone regeneration in the tooth extraction socket. Our new findings provide a novel stem cell treatment for the prevention of BRONJ.

Restoration of Lost Interdental Papilla: A Surgical Technique.

Loss of interdental papilla due to trauma or inflammatory periodontal diseases presents significant esthetic-zone challenges to clinicians. Miniscule working spaces and limited blood supply to these areas render conventional surgical techniques somewhat unpredictable. The implementation of vertical releasing incisions can further jeopardize blood supply and leave unattractive scarring upon healing. This article discusses a surgical technique utilizing microscopes and microsurgical instruments to more effectively achieve esthetic results. Additionally, the article provides a brief overview on the development of periodontal plastic and reconstruction surgery and updated information to support previously published reports by this author.

Laser therapy as an adjunct in the treatment of sodium hypochlorite extrusion through a root perforation: a case report.

Accidental sodium hypochlorite extrusion can occur during endodontic irrigation procedures. The symptoms appear immediately and include severe pain, swelling, and probable tissue necrosis adjacent to the root of the treated tooth. Treatment of sodium hypochlorite extrusion involves immediate and copious saline irrigation to neutralize the area and prescription of analgesic, anti-inflammatory, and antibiotic medications. Low-level laser therapy (LLLT) might be useful as an adjuvant treatment for damaged soft tissues to improve healing. This case report describes the treatment of accidental extrusion of 1% sodium hypochlorite through a root canal perforation in a mandibular incisor during endodontic treatment. The extrusion caused minor swelling within the mentolabial sulcus and a large area of necrosis in the gingivolabial mucosa and right edentulous premolar area. Conventional treatment was performed in association with LLLT. Clinical and radiographic examinations after 6 months showed complete healing of the necrotic area without paresthesia and the repair of apical tissues.

High glucose-induced oxidative stress impairs proliferation and migration of human gingival fibroblasts.

Delayed gingival wound healing is widely observed in periodontal patients with diabetes. However, the molecular mechanisms of the impaired function of gingival fibroblasts in diabetes remain unclear. The purpose of this study was to investigate changes in the properties of human gingival fibroblasts (HGFs) under high-glucose conditions. Primary HGFs were isolated from healthy gingiva and cultured with 5.5, 25, 50, and 75 mM glucose for 72 h. In vitro wound healing, 5-ethynyl-2'-deoxyuridine (EdU), and water-soluble tetrazolium salt (WST-8) assays were performed to examine cell migration and proliferation. Lactase dehydrogenase (LDH) levels were measured to determine cytotoxicity. The mRNA expression levels of oxidative stress markers were quantified by real-time PCR. Intracellular reactive oxygen species (ROS) were also measured in live cells. The antioxidant N-acetyl-l-cysteine (NAC, 1 mM) was added to evaluate the involvement of ROS in the glucose effect on HGFs. As a result, the in vitro wound healing assay showed that high glucose levels significantly reduced fibroblast migration and proliferation at 6, 12, 24, 36, and 48 h. The numbers of cells positive for EdU staining were decreased, as was cell viability, at 50 and 75 mM glucose. A significant increase in LDH was proportional to the glucose concentration. The mRNA levels of heme oxygenase-1 and superoxide dismutase-1 and ROS levels were significantly increased in HGFs after 72 h of exposure to 50 mM glucose concentration. The addition of NAC diminished the inhibitory effect of high glucose in the in vitro wound healing assay. The results of the present study show that high glucose impairs the proliferation and migration of HGFs. Fibroblast dysfunction may therefore be caused by high glucose-induced oxidative stress and may explain the delayed gingival wound healing in diabetic patients.

FOXO1 regulates VEGFA expression and promotes angiogenesis in healing wounds.

Angiogenesis is a critical aspect of wound healing. We investigated the role of keratinocytes in promoting angiogenesis in mice with lineage-specific deletion of the transcription factor FOXO1. The results indicate that keratinocyte-specific deletion of Foxo1 reduces VEGFA expression in mucosal and skin wounds and leads to reduced endothelial cell proliferation, reduced angiogenesis, and impaired re-epithelialization and granulation tissue formation. In vitro FOXO1 was needed for VEGFA transcription and expression. In a porcine dermal wound-healing model that closely resembles healing in humans, local application of a FOXO1 inhibitor reduced angiogenesis. This is the first report that FOXO1 directly regulates VEGFA expression and that FOXO1 is needed for normal angiogenesis during wound healing. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Treatment of a Gingival Injury From a Cosmetic Laser Burn: A Case Report.

Gingival depigmentation is a periodontal plastic surgery procedure for the removal of pigmented gingiva. A gingival depigmentation procedure can be accomplished with the use of a laser; however, as described in this case report, laser burns can be associated with such a procedure, and if one occurs it must be subsequently managed. In this case, the patient presented with a large elliptical ulceration at the right maxillary premolar region. The underlying alveolar bone was exposed and the surrounding gingival margins were inflamed. After debridement of the area and removal of sequestrated bone, a bone graft and subepithelial connective tissue graft were placed using a microsurgery technique to correct the defect. This case report is intended to raise awareness regarding the potential complications of laser gingival depigmentation and present a possible treatment approach for such complications.

Teachers' knowledge concerning dental trauma and its management in primary schools in Riyadh, Saudi Arabia.

OBJECTIVES: The main aim of this cross-sectional study was to assess knowledge concerning traumatic dental injuries and their management among primary schoolteachers in Riyadh, Saudi Arabia. The secondary objective was to evaluate the effect of gender, nationality, marital status, school type, geographical area, age group, level of education and years of experience on teachers' knowledge. METHODOLOGY: Data were collected, through a self-administered questionnaire, from both male and female teachers employed in public and private primary schools in the five geographical areas of Riyadh City. The total sample size was 1,520 teachers. Data were entered into the Statistical Package for the Social Sciences. Frequencies and percentages were calculated. An independent t-test and a one-way analysis of variance (ANOVA) were used to calculate significance. RESULTS: The total score for the questions assessing knowledge was calculated out of 9, and the highest score was 7 with an average score of 2.85. Over half of the sampled participants stated that they did not know how to manage soft-tissue injuries. Regarding the management of fractured teeth, 38.8% believed that the fractured part is useless; and for the management of an avulsed permanent tooth, only 6.2% of the respondents selected the correct answer. For the question regarding suitable storage medium of an avulsed tooth, only 19.7% chose milk and 3.2% chose the injured person's saliva. Teachers between 41 and 50 years of age and those with longer years of experience had the highest level of knowledge. Teachers in the north area of Riyadh had a higher level of knowledge than teachers in other areas. CONCLUSION: There was a lack of knowledge among primary schoolteachers in Riyadh concerning traumatic dental injuries and their management. Statistically significant differences were found among geographical areas, age groups and years of experience; no statistically significant differences were found regarding gender, nationality, marital status, level of education and school type (public/private).

Treatment of gingival defects with gingival mesenchymal stem cells derived from human fetal gingival tissue in a rat model.

BACKGROUND: The study aimed to evaluate the efficacy and safety of gingival mesenchymal stem cells (GMSCs) from human fetal gingival tissue used for treating gingival defects in a rat model. METHODS: GMSCs were isolated from human fetal gingival tissue and identified by flow cytometry for nestin, Oct4, vimentin, NANOG, CD105, and CD90. The immunogenicity of GMSCs was analyzed by mixed lymphocyte reactions; the tumorigenicity of GMSCs was evaluated by xenotransplanting into nude mice. The gingival defect animal model was established by mechanical resection in rats. GMSCs were transplanted into the defective area, and the regeneration of gingival tissue was observed twice weekly. Four weeks after transplantation, the gingival tissue was surgically cut down, and the graft was analyzed by immunohistochemistry staining for human mitochondrial antigens and rat CD3 and CD20. RESULTS: GMSCs from human fetal gingival tissue positively expressed nestin, Oct4, vimentin, NANOG, CD105, and CD90. There was no cell aggregation after mixed lymphocyte reactions, and interleukin-2 did not increase. Inoculation of GMSCs into nude mice for 6 months showed no tumor formation. GMSCs were transplanted into the gingiva defects of rats. One week after transplantation, the defect area was reduced, and after 3 weeks the morphology and color of local gingival tissue was similar to normal gingival tissue, and gingival height was the same as the normal control group. CONCLUSIONS: Using GMSCs from human fetal gingival tissue to treat gingival defects is a safe and effective innovative treatment method.

Effect of Consecutive Removal and Placement of Abutments during Prosthetic Procedures on an Increase in Proinflammatory Cytokine Levels around Dental Implants

Objective: To evaluate the effect of repeated removal and placement of abutments during prosthetic stages on increasing proinflammatory cytokine levels around dental implants. Material and Methods: All the patients with dental implants, referring to the prosthodontics private office during a 3-month period, were examined in relation to the health of the implants and included in the present study based on inclusion criteria; the patients had a multi-unit abutment on one side of the jaw and a conventional healing abutment on the implant on the other side of the jaw. Samples of gingival crevicular fluid were taken from all the eligible subjects for immunological analyses. The samples were taken from the sulcus around each implant in each subject. The samples were sent to the immunology laboratory for determination of IL-6 and IL-1ß proinflammatory cytokines with the use of an ELISA kit. Data were analyzed with SPSS 16 and Descriptive statistics and T-test was used. Statistical significance was set at p<0.05. Results: The results showed that the mean concentrations of IL-1ß and IL-6 in the group with multi-unit abutment were less than those in the conventional abutment group. In addition, comparison of the means of IL-6 and IL-1ß concentrations showed that in both groups the concentration of IL-6 was higher than that of IL-1ß. Conclusion: The use of multi-unit abutments resulted in less inflammation compared to the use of conventional two-segment abutments, which require repeated removal and placement during the prosthetic stage.

Histological Gingival Assessment after Conventional and Laser Gingivectomy.

BACKGROUND: Gingivectomy is a procedure often performed in everyday clinical practice using numerous instruments. AIM: To evaluate and compare the gingival cut surface after gingivectomy with 6 different surgical instruments - a surgical scalpel, an Er:YAG laser, a CO2 laser, a ceramic bur, an electrocautery device, and a diode laser. MATERIALS AND METHODS: Gingivectomy using the above listed instruments was performed in 18 patients. The histological samples excised with a surgical scalpel were assigned as a control group and the other five types - as test groups. The following histological parameters were measured: coagulation layer thickness (in µm); presence or absence of a microscopic rupture and presence or absence of hemostasis in-depth. RESULTS: The best instrument of the above listed ones which demonstrated excellent results is the CO2 laser. The Er:YAG laser has a thin coagulation layer and lack of hemostasis in-depth. The diode laser has the widest coagulation layer which is an advantage from a clinical point of view. Electrocautery proved to be as effective as the diode laser, but it should not be used around metal restorations. The ceramic bur has less pronounced hemostasis in-depth. CONCLUSIONS: Modern dentistry uses a wide variety of methods that are designed to be applied in everyday practice. Good knowledge of the ways to use them, their advantages and disadvantages is essential to obtaining the optimal result depending on the clinical case.

[A PhD completed. Trauma to the gingiva by oral hygiene aids and oral piercings]. / Tandvleesschade door mondhygiënemiddelen en mondpiercings.

Maintaining healthy teeth and soft oral tissue is important. Clinical research has shown manual toothbrushes with end-rounded filaments to cause significantly less gingival abrasions than those without end-rounding. Tapered filaments are an alternative to end-rounded filaments, but there is no solid evidence for their effectiveness. For the interdental spaces that the toothbrush doesn't reach, the use of special oral hygiene aids is advised. Clinical studies of gingivitis patients have shown that both interdental brushes and plastic-rubber bristles reduce gingivitis after 4 weeks of use. Plastic-rubber bristles result in a significant improvement in the tendency for interdental bleeding compared with interdental brushes, and they cause less abrasion of the gingiva. Other factors that can potentially traumatise soft and hard oral tissue are oral piercings. Wearing oral piercings is not without risk. Tongue and lip piercings are associated with the risk of gingival recession, and tongue piercings are associated with tooth fractures. To prevent the risk of complications, patients should be discouraged from wearing oral piercings.

A report on the clinical-pathological correlations of 788 gingival lesion

Background: The diagnosis and treatment of a variety of non-plaque related gingival diseases have become an integrated aspect of everyday dentistry. The aim of this study was to analyse the relationship between clinical appearance and histopathological features of gingival lesions in a large Northern Italian population. Material and Methods: A retrospective study of 788 cases of gingival and alveolar mucosal biopsies was set up. Statistical analysis was performed by calculating the odds ratio and 95% confidence interval (C.I.), in order to assess the degree of association between the clinical parameters considered (primary lesions) and the single pathologies, statistically evaluated by Mantel-Haenszel tests. The correlation between clinical and histological diagnosis was classified as follow: 1) expected data (ED): provisional clinical diagnosis; 2) real data (RD): final histopathology diagnosis; 3) concordant data (CD): correspondence between the expected data and real data. The correlation was calculated as follow: CC (complete concordance) = CD x 100 / ED, this expressing the percentage in which the clinical and the histological diagnosis overlapped. Results: The most frequently observed and biopsied primary lesions resulted to be exophytic, followed by mucosal colour changes and finally by losses of substance. The statistically significant association between primary lesion and their manifestation in gingival pathologies was reported. Volume increases, for instance, were positively correlated to plasma cell epulis, pyogenic granuloma, fibrous reactive hyperplasia and hemangioma. Verrucous-papillary lesions were most often seen in verrucous carcinoma, verrucous leukoplakia and mild dysplasia. White lesion resulted to be related to leukoplakia or oral lichen planus. Red lesions resulted to be related only oral lichen planus. Erosive vesicle-bullous lesions were linked to disimmune pathologies. Ulcerative lesions were positively associated to oral squamous cell cancer. Finally, potentially malignant disorders have the most percentage high concordance. Among the malignant lesions, the correlation increased up to the squamous cell carcinoma and leukaemia. Conclusions: This article presented the frequency and the clinico-pathological concordance of all primary lesions and the histopathological diagnosis of gingival lesions. For every primary lesion, it is possible to correlate a specific histopathological diagnosis in a statistical manner. This can be a valuable aid for not specialist clinicians who daily observe mucosae and have the opportunity to intercept major diseases (AU)

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Connexin 43 Hemichannels Regulate the Expression of Wound Healing-Associated Genes in Human Gingival Fibroblasts.

Connexin 43 (Cx43) is the most ubiquitous connexin in various cells, and presents as hemichannels (HCs) and gap junctions (GJs) on the cell membrane. We have recently shown that Cx43 abundance was strongly reduced in fibroblasts of human gingival wounds, and blocking Cx43 function in cultured human gingival fibroblasts (GFBLs) strongly regulated the expression of wound healing-related genes. However, it is not known whether these responses involved Cx43 HCs or GJs. Here we show that Cx43 assembled into distinct GJ and HC plaques in GFBLs both in vivo and in vitro. Specific blockage of Cx43 HC function by TAT-Gap19, a Cx43 mimetic peptide, significantly upregulated the expression of several MMPs, TGF-ß signaling molecules, Tenascin-C, and VEGF-A, while pro-fibrotic molecules, including several extracellular matrix proteins and myofibroblast and cell contractility-related molecules, were significantly downregulated. These changes were linked with TAT-Gap19-induced suppression of ATP signaling and activation of the ERK1/2 signaling pathway. Collectively, our data suggest that reduced Cx43 HC function could promote fast and scarless gingival wound healing. Thus, selective suppression of Cx43 HCs may provide a novel target to modulate wound healing.

Regeneration of gingival tissue using in situ tissue engineering with collagen scaffold.

OBJECTIVE: The aim of the study was to evaluate 2 types of collagen scaffold for gingival regeneration. STUDY DESIGN: Two types of collagen scaffolds, CS-pH7.4 and CS-pH3.0, were prepared by processing atelocollagen at pH 7.4 or 3.0, respectively, followed by dehydrothermal treatment. Gingival wounds with sizes of 4 × 6 mm (rectangle) or 6 mm diameter (circle) were made with buccal incisions in beagle dogs. The defective area was surgically covered with the CS-pH7.4, CS-pH3.0, or no scaffold (control). Gingival regeneration was assessed by monitoring the differences in the lengths of the epithelial and submucosal tissues at the wound site and the normal site. Histopathologic assessments were performed by 4 evaluators independently; statistical significance was evaluated by using the Wald test. RESULTS: Significantly higher recovery of epithelial and submucosal tissues, which, in turn, resulted in recovery of gum thickness, was observed in gingival wounds treated with the CS-pH7.4 compared with that in the control. CS-pH3.0 treatment also resulted in higher gingival regeneration compared with the control; however, the effects were more pronounced in wounds treated with the CS-pH7.4. CS-pH7.4-treated wounds showed better gingival regeneration compared with the control and CS-pH3.0-treated wounds, even after adjusting for interevaluator differences using a linear mixed model. CONCLUSIONS: CS-pH7.4 is a promising scaffold for gingival tissue regeneration.

Alveolar Fracture Caused by Tooth Extraction at Home.

Injuries to the teeth and surrounding structures are relatively common. Although traumatic injuries caused by falls or activities related to sports are widely discussed, the same cannot be said regarding accidents arising from non-professional extraction of primary teeth. The present study reports a 6-year-old male child who underwent mandibular alveolar bone fracture during non-professional extraction of his central lower left incisor at home, performed by his 30-year-old aunt. The root of the tooth was with an irregular physiological resorption, which acted as a lever component for the mechanical force applied, leading to bone fracture. Although not common, the possibility that dental roots with irregular resorption can act as a possible risk factor for accidents if the parents or guardians of children during the period of transitional dentition try to perform intentional extraction of primary teeth should be highlighted. Parents should always consult a professional, preferably a pediatric dentist, for monitoring this period of transitional dentition.

Chemical burn to the gingiva after misuse of an over-the-counter oral whitening mouthwash.

A well-recognized consequence of the use of tooth whitening gels and strips, particularly prescription strength formulations, is gingival irritation and tooth sensitivity. Limited information is available in the literature on the risk of gingival chemical burns associated with over-the-counter (OTC) oral whitening rinses. This case report details the development of gingival chemical burns consequent to misuse of a whitening rinse. The affected patient had rinsed for 30 seconds daily for 3-4 days but had failed to rinse with water after usage, as specified by the manufacturer. Within 2 weeks, successful resolution of the gingival injury was achieved through product withdrawal and saline rinses. Patients should be familiar with the manufacturer's designated instructions for OTC oral healthcare products and be advised to use them cautiously.