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PubMed2001

Gingival plasma cell granuloma.

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.

Diagnosis, Differential↗
PubMed2002

The effects of periodontal therapy on intracrevicular prostaglandin E2 concentrations and clinical parameters in pregnancy.

BACKGROUND: The increase in circulating levels of progesterone during pregnancy stimulates production of prostaglandins, especially prostaglandin E2, possibly resulting in pregnancy gingivitis. The purpose of this study is to evaluate the influence of prostaglandin E2 concentrations on gingival tissues in pregnancy and to assess its relationship to clinical parameters. METHODS: This study evaluates the effects of periodontal treatment on clinical indices including plaque index, gingival index, probing depth, and gingival crevicular fluid prostaglandin E2 levels of 22 pregnant women in their first, second, and third trimesters. Initial periodontal therapy consisting of scaling, root planing, and oral hygiene instruction was performed at the beginning of the first trimester and repeated each trimester. Prostaglandin E2 concentrations in gingival crevicular fluid were determined using a commercially available enzyme immunoassay kit. The statistical tests used were paired sample test and correlation analysis. RESULTS: The results of the study show that periodontal therapy has resulted in an improvement in clinical parameters (P<0.05). There is also a statistically significant decrease in levels of prostaglandin E2 at the second and third trimesters following periodontal therapy (P <0.001). The correlation between prostaglandin E2 concentrations and clinical parameters is found to be non-significant (P >0.05). CONCLUSIONS: Our data indicate that levels of prostaglandin E2 in gingival crevicular fluid may be used as a marker of gingival inflammation in order to determine the effects of periodontal therapy in pregnancy. Periodontal therapy that is performed throughout the entire pregnancy period may help prevent the threat of pregnancy gingivitis.

Adult↗
PubMed2002

Large cell carcinoma of the lung metastatic to the mandibular gingiva.

BACKGROUND: Although metastases of malignant tumors to the jaws are not unusual, metastases to the gingival soft tissues are relatively rare. METHODS: The clinicopathologic features of a metastatic tumor in the mandibular gingiva originating from lung cancer are described. The patient, a 61-year-old man, was admitted to the hospital with complaints of bloody sputum and chest pain while coughing. The patient's chest radiograph showed an abnormal mass in the left upper lobe. After admission, the patient noticed a swelling of the right mandibular gingiva. Histological and immunohistochemical analysis for tumors of the gingiva and the lung were performed. RESULTS: Radiographic examination did not indicate involvement of the underlying bone. The histopathological findings showed that the gingival tumor consisted of a large cell carcinoma, and the mass of the upper lobe displayed the same histology as that found in the gingiva. Immunohistochemical investigation of the gingival tumor revealed similar results to those found in the mass of the lung. Based on the clinicopathologic findings, this case was diagnosed as primary lung cancer with the gingival tumor deemed metastatic. Multiple metastases were found in areas other than the oral cavity; radiation and chemotherapy for the gingival tumor were performed due to persistent bleeding and pain. CONCLUSIONS: The resemblance of this gingival mass to an inflammatory lesion demonstrates the need for a detailed examination. This case also emphasizes the need to evaluate positive treatment needed to relieve complications in the mouth, even if the prognosis of the primary tumors remains unfavorable.

Carcinoma, Large Cell↗
PubMed2003

Gingival/soft tissue abscess following subepithelial connective tissue graft for root coverage: report of three cases.

BACKGROUND: The subepithelial connective tissue graft (SCTG) is a predictable technique for root coverage. The small number of potential postoperative problems make SCTG the current treatment of choice for reversing gingival recession. METHODS: The purpose of this article is to report three cases of complications after the use of an SCTG where an abscess occurred following the initial healing phase. The surgical technique that was used and the treatment that was provided for the abscesses are reported, and the possible causes of these complications are discussed. RESULTS: The abscesses were treated conservatively, and no recurrence has been observed after treatment. CONCLUSIONS: Possible causes of the abscesses include "stitch abscess" or reaction to the suture material used for the submerged sutures, or a possible role of epithelium implanted during the procedure. The clinical outcome of the root coverage procedure was not affected.

Abscess↗
PubMed2003

A gingival cul-de-sac following a root coverage procedure with a subepithelial connective tissue submerged graft.

BACKGROUND: The subepithelial connective tissue graft (SCTG) used as a submerged graft in combination with a partial thickness advanced flap or rotated flap is a predictable technique for achieving coverage of the denuded root surface and/or for increasing the width of attached gingiva in Miller's class I and II marginal tissue recessions. However, even with a successful result, complications may occasionally occur. METHODS: A 4-mm marginal tissue recession with an insufficient zone of attached gingiva on the facial aspect of a mandibular left lateral incisor (#23) was covered with a submerged SCTG and an envelope partial thickness flap. The mucogingival defect was successfully corrected. Nevertheless, the facial gingiva, specifically between teeth #22 (mandibular left canine) and #23, remained bulky and was reshaped 6 months postoperatively. A 5-mm long gingival cul-de-sac with an intermittent thick white discharge was detected 3 months following the gingivoplasty procedure. RESULTS: With a periodontal probe kept in the tract, the lining of the cul-de-sac was exposed to the oral cavity by making an incision on the facial gingiva, along the axis of the probe, through to the lumen. The gingival tissue was then removed with a rotary bur until only a thin layer of periosteum remained. The mucosal defect was subsequently repaired by grafting with a non-submerged SCTG. The gingival contour was significantly improved and no sign of recurrence was noted up to 4 years later. CONCLUSIONS: The existence of a cyst cannot be verified without a histological evaluation. However, the development of a gingival cyst should be suspected with persistent tissue bulkiness and/or emergence of a thick white discharge from a site where a submerged SCTG procedure was performed. In addition, the ill-circumscribed border around the lesion makes complete elimination of the pathosis relatively hard to achieve by a "superficial" gingivoplasty procedure.

Adult↗
PubMed2006

Management of interdental papillae loss with forced eruption, immediate implantation, and root-form pontic.

BACKGROUND: A 25-year-old Asian woman complained of an unesthetic black triangle between her upper right front teeth. Defective interdental papillae may result from external root resorption, which makes esthetic restoration more difficult. A combined use of forced eruption, immediate implant placement, and a root-form pontic made a successful esthetic and functional restoration. METHODS: The treatment sequences of this patient included short-term forced eruption, subsequent immediate implant placement after tooth extraction, and a provisional root-form pontic restoration. A final prosthesis was completed 6 months later, followed by clinical maintenance. RESULTS: Papillae were augmented by forced eruption. After immediate implantation and root-form pontic placement had been performed, the peri-implant soft and hard tissues were manipulated and maintained in a stable state. CONCLUSIONS: We successfully reconstructed the interdental papillae and replaced the deficient tooth with an immediate implantation. During 2 years of follow-up, the implant and peri-implant structures remained stable and healthy.

Adult↗
PubMed1989

[Role of attached gingiva in the extension of gingival inflammation. An experimental study in monkeys].

The purpose of this study was to evaluate the inflammatory response in dento-gingival units with or without attached gingiva in monkeys. Two different types of dento-gingival units with or without attached gingiva were established in premolar and first molar areas of three monkeys. In the experimental group, a part of the keratinized gingiva was removed with periodontal scissors following mucoperiosteal flap procedure, while in the control group, sham surgery was performed. After the surgery, plaque control was performed by mechanical tooth cleaning procedures three times a week for 3 months. As baseline examinations, width of the keratinized gingiva, probing pocket depth, position of the gingival margin, and the clinical attachment level were recorded and oral photographs were taken. Following these examinations silk ligatures were placed around the neck of the teeth to induce gingival inflammation in both the experimental and control groups. A soft diet which allowed plaque accumulation on the teeth was given during the experimental periods. The clinical examinations were carried out at 0, 1, 2, 3, 5 and 12 weeks and all monkeys were sacrificed for histological examination. The results obtained were as follows: 1. The use of silk ligature and a soft diet produced moderate to severe gingival inflammation in the monkeys. 2. The degree of gingival inflammation was greater in the experimental group which was characterized by the absence of the attached gingiva. 3. Marked marginal tissue recession with an apical shift of the attachment level was found in the gingival units of the experimental group at 12 weeks. 4. Histologically, a distance between the level of notch on the root surface and the most apical position of epithelial cell was greater in the experimental groups at 5 and 12 weeks, compared with the pre-experimental level. 5. The degree of alveolar bone resorption was higher in the experimental group at 5 and 12 weeks. These results suggest that an attached gingival tissue plays a certain role as a barrier against the extension of gingival inflammation.

Animals↗
PubMed2000

Relationship between gingival health and dental caries in children aged 7-12 years.

The purpose of this study was to investigate the relationship between gingival health and dental caries in elementary school children in Japan. The subjects were 474 children aged 7 to 12 years who attended dental check-ups at an elementary school. The Oral Rating Index for Children, which consists of five categories (+2, +1, 0, -1, -2), was used to rate the findings of the gingival health examination. The dental examination was performed using the WHO caries diagnostic criteria for DMFT. Children were divided into three groups: a healthier group (H-group) made up of those scoring +2 (excellent) or +1 (good), an equivocal group (E-group) made up of those scoring 0, and a gingival less-healthy group (L-group) made up of those scoring -2 (very poor) or -1 (poor). Overall percentages for the H-group, E-group and L-group were 48.3%, 21.5% and 30.2%, respectively. The number in the L-group increased with increasing age. The mean scores of the DT and DMFT in the H-group were significantly lower than those in the L-group (p < 0.01 and p < 0.05, respectively). The results suggest that oral hygiene instruction should be given to children in order to motivate self-care, not only to avoid dental caries but also to prevent gingivitis.

Age Factors↗
PubMed2000

Behavioral dental science: the relationship between tooth-brushing angle and plaque removal at the lingual surfaces of the posterior teeth in the mandible.

The aim of this study was to investigate the relationship between tooth-brushing angle and efficacy of plaque removal. The subjects in this study were 72 students (18-21 yrs.) from paramedical schools. They answered the questionnaire of the Hiroshima University-Dental Behavioral Inventory (HU-DBI) to assess dental health behavior, and then received examinations of tooth-brushing angle, efficacy of plaque removal and gingival condition. The examination sites of tooth-brushing angle and the efficacy of plaque removal were the lingual surfaces of the posterior teeth in the mandible. The tooth-brushing angle, efficacy of plaque removal, gingival condition and dental health behavior were significantly associated with each other. The subjects who directed the bristles of the toothbrush vertically toward the tooth surfaces had a high efficacy of plaque removal, good gingival condition and good dental health behavior. Thus, it is important to direct the bristles vertically toward the tooth surfaces for effective plaque removal. In addition, knowledge related to good dental health might be necessary to carry out effective tooth brushing.

Adolescent↗
PubMed2006

Oral pyogenic granuloma: a review.

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.

Contraceptives, Oral↗
PubMed1978

Peridontal status following surgical-orthodontic alignment of impacted teeth.

Treatment of impacted teeth is often a combination between oral surgery and orthodontics. This study evaluates the gingival condition of impacted teeth after surgical-orthodontic treatment, where two different surgical methods were used. In one group (n = 11) the teeth were radically exposed and orthodontically moved to their final position. In the other group (n = 11) the teeth were partially exposed by raising a mucoperiosteal flap. Orthodontic traction was then applied; whereafter the flap was sutured back into place. The results showed that one of the teeth in the partial exposure group and seven in the radical exposure group showed loss of attachment. This study indicates that a combination of mucoperiosteal flap technique and applied orthodontic traction is prefered to minimize the loss of attachment in cases of displaced impacted teeth.

Adolescent↗
PubMed1980

Post-treatment periodontal status of labially erupted maxillary canines.

This study evaluates the level of the gingival margin of labially erupted maxillary canines after orthodontic treatment in a sample of 47 individuals with a mean age of 14.2 years. Gingival recession was found in 33% of the canines with a high labial eruption pattern, and in 11% of those with a moderate labial eruption. A highly significant correlation was found between the clinical crown height and the original degree of high labial eruption. The evidence of this study supports the case for implementation of interceptive orthodontic treatment in order to prevent high labial eruption of maxillary canines.

Adolescent↗
PubMed1997

Determinants of self-assessed gingival health among adolescents.

The purpose of the present cross-sectional study was to assess the extent of agreement between clinical and self-assessed gingival health and to investigate possible factors associated with the amount of self-assessed gingival bleeding. A study group comprising students enrolled in grade 7 or 8 in Helsinki, Finland (n = 172), performed a self-assessment based on two tests: the amount of bleeding after toothbrushing and after interproximal tooth cleaning with toothpicks. Clinical examinations based on bleeding on probing (BOP%) were carried out by four local community dentists. The highest observed kappa value was 0.43 for the agreement between BOP% and self-assessment when tested with different cut-off points of diagnosis. Multivariate analysis showed that clinical status and toothbrushing frequency were statistically significantly associated with self-assessed gingival bleeding in both tests. Socioeconomic status and locus of control orientation were also statistically significant factors in the toothpick test. In conclusion, the validity of self-assessment of bleeding was sufficient for monitoring adolescents' gingival health in groups. Self-assessed bleeding was explained by the same factors that were associated with clinical gingival health status.

Adolescent↗