A case report of gingival enlargement associated with invasive cervical resorption.

Invasive cervical resorption (ICR) is a rare external dental resorption with unknown etiology; it progresses asymptomatically in the cervical area of the permanent teeth. Lesions are mostly misdiagnosed as internal resorption or caries, which leads to erroneous treatments. This case report presents the clinical and radiological diagnosis, as well as the results of treatment and 3-year follow-up in a 50-year-old female patient with gingival enlargement associated with ICR in tooth No. 25. Granulation tissue was removed by accessing the cervical resorption area through a flap operation. Following the endodontic treatment, the tooth was restored using composite resin and the hyperplastic lesion was excised. In conclusion, it should be kept in mind that clinical, radiological, and pathological evaluation in the differential diagnosis of localized hyperplastic lesions in the gingiva is of importance and that ICR could play a role in the etiology of these lesions.

Immunoexpression of angiogenesis and proliferation markers in patients treated with cyclosporin A.

AIM: In the present immunohistochemical study, the expression of vascular endothelial growth factor, nitric oxide synthase 1 and 3, and Ki-67 in the gingival tissues of renal transplant patients treated with cyclosporin A was assessed. Gingival overgrowth (GO) frequently occurs in transplant patients receiving immunosuppressive drugs such as cyclosporine and this gingival inflammation might play an important role in the pathogenesis of drug-induced GO. METHODS: Twenty-eight human gingival biopsies were taken from healthy patients with chronic periodontitis (N.=14 control group), and from renal transplant recipients treated with cyclosporin A (N.=14 test group). The retrieved specimens were immunohistochemically processed and stained for vascular endothelial growth factor, nitric oxide synthase 1 and 3, and Ki-67. RESULTS: The levels of vascular endothelial growth factor, nitric oxide synthase 1 and 3, and Ki-67 were found to be significantly different among groups (P>0.001), with patients treated with cyclosporin A showing higher levels of all the analyzed markers compared to control group. CONCLUSION: In summary, the data from this pilot study suggests that the investigated factors have a role in the inflammation processes associated to immunosuppressive therapy. However, further studies with a larger sample population need to be conducted for an exhaustive knowledge of the mechanisms leading to GO.

Primary extranodal non-Hodgkin's lymphoma presenting as painful gingival swelling.

Primary extra-nodal non-Hodgkin's lymphomas (NHL) constitute 25-40% of NHL but less than 1% arises in oral cavity. Here in 53-year-old man with stage IE gingival diffuse large B cell lymphoma who was treated successfully with chemotherapy and radiotherapy was presented.

Acute leukemias: a dentist's perspective.

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.

Collagen IV and MMP-9 expression in hypertrophic gingiva during orthodontic treatment.

INTRODUCTION: In the present study, we aimed to assess MMP-9 and type IV collagen in the gingival tissue in patients with gingival overgrowth (GO) after orthodontic treatment, with or without clinical signs of inflammation to appreciate the role of balance between those two markers in the onset of GO during tooth movement. MATERIALS: Gingival tissue was harvested from 45 patients divided in three groups: 15 patients with orthodontic appliance that developed GO on at least two teeth; 15 patients with chronic gingivitis with GO; 15 patients (control group) with healthy periodontal tissues, without clinical gingival changes, in whom the first premolar was planned for extraction for orthodontic purposes (canine distalization). METHODS: The tissue samples obtained by gingivectomy were fixed in 10% neutral formalin solution for 48 hours and then included in paraffin with the usual technique. The histologic examination was performed using classic Hematoxylin-Eosin technique. Double immunofluorescence was performed for anti-MMP-9 and anti-collagen IV antibodies. RESULTS: MMP-9/collagen IV double stainings showed an increase of fibrosis and inflammation in different degrees. CONCLUSIONS: The mechanical stress induced by the orthodontic devices, might be the key players in driving both the inflammation and the fibrotic reaction.

Morphological study of the palatal gingiva of the maxillary first molar in the type 2 diabetes mellitus model rat.

SUMMARY: We studied morphological changes at the maxillary first molar in a model rat for type 2 spontaneous diabetes mellitus (DM), the Goto-Kazizaki (GK) rat, vs. the normal 8-week-old Wistar rat. Serial frontal sections of the gingiva of the maxilla with the bone were prepared from the rats. Image analyses, performed on light micrographs of the hematoxylin-eosin stained specimens, allowed comparison of the thickness of the keratinized, granular, prickle, and basal layers. In addition, the cell population of the granular and prickle layers and the cross-sectional area of the connective tissue beneath the mucosal epithelium were examined. The thickness of the capillary of the maxillary first molar was determined by image analysis of scanning electron micrographs of microvascular corrosion cast specimens. We found that the thickness of the keratinized, granular, and prickle layers was significantly higher in the DM vs. normal group, as were the cell population of the granular and prickle layers. In contrast, the cross-sectional area of the connective tissue beneath the mucosal epithelium, and the thickness of the capillary were significantly lower in the DM vs. normal sections. Therefore, we consider that the DM-associated hyperglycemia causes hypertrophy of the mucosal epithelium, atrophy of the connective tissue beneath the mucosal epithelium, and microangiopathy of the capillary of the palatal gingiva of the maxillary first molar in the GK rat.

Hipertrofia gengival induzida por anlodipina: [revisão] / Amlodipine induced gingival overgrowth: [review]

JUSTIFICATIVA E OBJETIVOS: A hipertrofia gengival (HG) é reconhecidamente um grave efeito adverso a medicamentos, frequentemente encontrado em pacientes em uso de imunossupressores, anticonvulsivantes ou anti-hipertensivos. Nesta última classe, se destaca a nifedipina, porém tem sido crescente o númerode casos secundários ao uso da anlodipina. O objetivo deste estudo foi observar na literatura os dados existentes sobre a epidemiologia, características clínicas e histopatológicas, a prevenção e o tratamento da HG associada a este fármaco. CONTEÚDO: A coleta de dados foi realizada através dos Bancos de Dados BIREME, Pubmed e Medline. As palavras pesquisadas foram: aumento gengival, hipertrofia gengival, hiperplasia gengival, amlodipine induced gingival overgrowth, gingival overgrowth induced by calcium channel blockers, drug induced gingival overgrowth. No bando de dados BIREME foram encontrados 24 artigos referentes ao assunto pesquisado, na Pubmed e Medline foram encontrados 47 artigos pertinentes ao contexto enfocado. Do total, foram utilizados 34 artigos na revisão de literatura. CONCLUSÃO: A anlodipina é um fármaco que comprovadamente atua no tecido gengival causando o seu aumento. Sendo assim, a HG induzida por este fármaco tem aspectos clínicos característicos e é uma reação adversa individualizada devido à influência multifatorial. Em razão do atual aumento do uso deste bloqueador de canal de cálcio, a incidência da HG torna-se cada vez mais crescente. Desta forma, por gerar comprometimento funcional e estético ao indivíduo acometido, é de suma importância o conhecimento desta condição pelos profissionais de saúde para que ocorra a correta identificação do quadro e o estabelecimento precoce de uma conduta terapêutica adequada.

BACKGROUND AND OBJECTIVES: Gingival hyperplasia(GH) is admittedly a severe adverse effect of medications, frequently found in the immunosupressors, anticonvulsivants or antihypertensives users. Among this last class of medications, nifedipine is featured, but adverse effects due amlodipine using have been increasing. The aim of this study was to examine the existing data on the literature about epidemiology, clinical and histopathological features, prevention and treatment of GH due this medication. CONTENTS: The data collection was performed through BIREME, Pubmed and Medline databases. The words searched were: gingival enlargement, gingival hypertrophy, gingival hyperplasia, amlodipine induced gingival overgrowth, gingival overgrowth induced by calcium channel blockers, drug induced gingival overgrowth. In the BIREME databases were found 24 articles concerningon the topic searched, in Pubmed and Medline were found 47 relevant articles focused on the context. Totally, 34 articles ofthe literature review were used. CONCLUSION: Amlodipine is a drug that acts in the gingival tissue inducing its enlargement. Therefore, GH induced by thisdrug has typical clinical features and is an individualized adverse effect by the multifactorial influence. Due to the current increasein the use of calcium channel blocker, the incidence of GH becomes increasingly common. However, by the functional and esthetic commitment of the affected individual, is of high importance the knowledge about this condition by health professionals aiming the correct identification of this case and the early establishment of an appropriate treatment.

Matrix metalloproteinase 9 levels in gingival crevicular fluid in patients after periodontal microsurgery for orthodontic induced gingival hypertrophy.

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.

Primary tuberculosis masquerading as gingival enlargement.

Background Tuberculosis is a chronic granulomatous disease and an enormous health problem. Oral lesions are relatively uncommon, however, pulmonary tuberculosis may manifest with the involvement of the gingiva as the only primary finding.Case description The present case study reports tuberculosis of the gingiva manifesting as gingival enlargement. The diagnosis was based on sputum examination, histopathology and immunologic investigations. Anti-tubercular therapy was carried out with remarkable changes in gingival health within four months.Clinical implications and conclusion Gingival tuberculosis is a relatively uncommon occurrence and this case study emphasises the need for the clinician to include tuberculosis in the differential diagnosis of various types of gingival enlargement. Early detection and prompt treatment is the key for management of this highly infectious and communicable disease.

Familial cherubism: the experience of the Moscow Central Institute for Stomatology and Maxillo-Facial Surgery.

The Central Institute for Stomatology and Maxillo-facial Surgery in Moscow is one the main centers for the treatment of pediatric head and neck tumors in the territory of the former Soviet Union. A series of 33 patients presenting with cherubism (24 children and 9 of their parents) is presented. The authors discuss the atypical clinical presentations, the relevant associated anomalies and the different treatment strategies. They report the first case of cherubism associated with gingival hypertrophy without neurological signs.