Cell populations associated with interdental gingival bleeding

Abstract. The purpose of this study was to characterize the cell populations of the mid-interproximal gingival tissue related to the presence or absence of bleeding. 15 bleeding and 15 non-bleeding interproximal gingival biopsies were obtained from 30 patients and processed for light microscopic evaluation. Morphometric analysis of tissue components revealed that bleeding was associated with an inflammatory lesion located in the mid-interproximal connective tissue. The inflammatory infiltrate was dominated by mononuclear cells of the lymphocyte/macrophage/monocyte group, and the proportions of plasma cells and polymor-phonuclear leukocytes were relatively small. The results of this study indicated that interproximal bleeding can be associated with an inflammatory infiltrate not dominated by plasma cells. The rôle of gingival bleeding in the diagnosis of periodontal disease activity is discussed.     

Interproximal gingival inflammation related to the conversion of a bleeding to a nonbleeding state

Elimination of gingival bleeding has been related to a reduction in inflammation; however, histologic data are not available to support this association. The purpose of this study was to characterize the histology of interproximal gingiva that was converted from a bleeding to a nonbleeding state. An interproximal gingival biopsy was obtained from each of 32 patients, 15 of whom bled upon stimulation with a soft wooden interdental cleaner. The remaining 17 biopsies were obtained from sites which initially bled, but were converted to nonbleeding by scaling and interproximal plaque control. Specimens were processed for light microscopic evaluation and subjected to a morphometric analysis for various tissue components. Data from bleeding and "stopped bleeding" specimens were compared using analysis of covariance. The results indicated that "stopped bleeding" specimens had significantly less inflamed connective tissue. It was concluded that the conversion of a bleeding to a nonbleeding state corresponds with a histological reduction in the magnitude of the interproximal inflammatory lesion and provides a rationale, therefore, for the use of bleeding to monitor the effects of therapeutic methods.     

Cell populations associated with active probing attachment loss.

The purpose of this study was to evaluate the ability of cell populations to differentiate between untreated progressing periodontitis sites (P) and untreated non-progressing sites (NP). Pairs of biopsies were obtained from untreated periodontal patients, one biopsy from a site which had lost probing attachment of 2 mm or more within the previous month, the other biopsy from a non-progressing site. Cell populations were identified on 1 micron sections in a defined connective tissue area at the junctional epithelium. The cell types counted were fibroblasts, mast cells, monocytes/macrophages, polymorphonuclear leukocytes (PMNs), lymphoid cells, plasma cells, endothelial cells, total inflammatory cells, and the total number of cells. The number of fibroblasts, mast cells, monocytes/macrophages, and inflammatory cells, as well as their percentage of the total number of cells, differed significantly between P- and NP-sites. In addition, the actual total counts differed between groups. The difference between groups was more significant for percent fibroblasts than for any other cell type. It appears that cell populations, particularly fibroblast counts, can aid in the histological discrimination between P and NP periodontitis lesions.     

Reduction in gingival overgrowth associated with conversion from cyclosporin A to tacrolimus

BACKGROUND: Unsightly gingival overgrowth affects many individuals immunosuppressed with cyclosporin A (CsA). Current management involves repeated periodontal surgery and intensive hygienist support. Tacrolimus is an effective alternative immunosuppressive agent for renal transplantation which does not appear to produce gingival enlargement. AIMS: The purpose of the present study was to monitor the gingival response of 4 renal transplant patients (RTPs), with clinically significant CsA-induced gingival overgrowth, after their immunosuppressive therapy was switched to tacrolimus. METHODS: Intra-oral photographs and alginate impressions were taken both prior to the drug conversion and again, 6 to 9 months later. Gingival overgrowth scores were determined, from plaster models on both these occasions. RESULTS: All of the RTPs experienced significant resolution of their gingival enlargement within the time period studied; however, only one had complete regression. CONCLUSION: It is concluded that conversion of RTPs with gingival overgrowth from CsA to tacrolimus may provide an effective management strategy for this clinical problem.     

Colonic adenocarcinoma with metastasis to the gingiva

Metastatic tumors involve the oral cavity, and the most common primary sites are the breast and lung. Most cases affect the mandible and maxilla in that order, although some of them can be located in the soft perioral tissues. We report the case of a 62-year-old male who had been diagnosed with sigmoid adenocarcinoma with nodal and liver metastasis, who presented 6 months later with a gingival polypoid tumor, at first considered as a primary neoplasm of gingiva, that was diagnosed in a biopsy as metastatic intestinal adenocarcinoma. The histological evaluation is essential to separate adenocarcinoma from the commoner in this site squamous cell carcinoma, and the immunohistochemical techniques are useful to distinguish metastatic tumor versus primary adenocarcinoma from the minor salivary glands of the area. The intraoral spread of a disseminated neoplasm is generally a sign of bad prognosis, although a longer survival can be expected if a radical surgical treatment of a solitary metastasis is carried out.     

Immunohistochemical analysis of the gingiva with periodontitis of type I plasminogen deficiency compared to gingiva with gingivitis and periodontitis and healthy gingiva

ObjectiveType I plasminogen deficiency (Plgdef) is an uncommon chronic inflammation of mucous membranes. Gingival enlargements usually proceed with progressive periodontal destruction and tooth-loss. Plasmin(ogen)-independent enzymatic mechanisms for fibrin clearance have already been discussed in the literature.Our primary objective was to verify, immunohistochemically, the occurrence of different enzymatic factors involved in tissue breakdown of inflamed compared to healthy gingiva.Secondly, we tried to find out, if these patients have a similar microbiological profile to the patients with known gingivitis and periodontitis.Materials and methodsImmunohistochemical analysis of enzymes elastase, plasminogen (plg), cathepsin G, matrix-metalloproteinase (MMP)-3 and MMP-7 and of glycoprotein fibrinogen were performed with gingival tissues from 3 healthy controls, 8 patients with Plgdef and 3 patients with gingivitis and periodontitis. Furthermore, plaque from 5 patients with plasminogen deficiency were also obtained to determine the microbiological profile.ResultsSignificantly high numbers of elastase positive leukocytes were detected in all samples. Staining for MMP-3 and MMP-7 was seen in samples with gingivitis and periodontitis with a stronger staining in samples with periodontitis by Plgdef. Fibrinogen was detectable in all samples. Staining for plg was stronger in samples with periodontitis than in other samples. Staining for cathepsin G was weak in gingivitis and periodontitis. Subgingival microbial flora showed elevated colony forming units of Prevotella intermedia/nigrescens, Fusobacterium spp., Eikenella corrodens, Porphyromonas gingivalis and viridans streptococci.ConclusionStrong staining of elastase, MMP-3 and MMP-7 and weak staining of plg in Plgdef samples supports the plasmin(ogen) – independent fibrin clearance. Similar subgingival microbiological flora was observed in periodontitis with Plgdef as in other periodontal diseases. Further investigations should determine the exact pathomechanism and focus on effective treatment methods of this entity.     

Epithelial-like cells in culture derived from human gingiva: response to nickel

ABSTRACT— To obtain gingival cell cultures, human gingival tissue was minced and/or subjected to trypsin treatment with or without prior separation into epithelial and connective tissue portions. The tissues were men incubated in Eagle/Earle's MEM with 10% fetal calf serum in a humidified atmosphere of 5% CO₂ in air. Fibroblast-like cell cultures were regularly obtained, and one culture showed epithelial-like cell islets that could be transferred and kept in continuous culture. These epithelial-like cells exhibited bone resorption stimulating activity as seen in gingival tissue and retained their growth pattern after prolonged storage. They were able to grow at serum concentrations down to 2.5% and with equal doubling time (about 17 h) in rich or minimum essential media. Exposure to nickel gave toxic effects on the growth at concentrations down to 2.5 μg/ml of nickel. In spite of the affinity of nickel to certain serum components, the serum concentration did not appear to be of specific importance to protect or aggravate the toxicity. It is felt that these cells may be of value for research on cytotoxicity of dental materials.     

Lingual perimandibular vessels associated with life-threatening bleeding: an anatomic study

PURPOSE: To describe the anatomy of the lingual perimandibular vessels and emphasize the distance to the bone. MATERIALS AND METHODS: The hemifacial lower third was dissected in 12 human cadavers. The blood vessels in the floor of the mouth were exposed using sagittal incisions at the canine, mental foramen, and second molar areas. RESULTS: The diameter of the dissected vessels ranged from 0.5 to 3 mm (mean, 1.5 mm). Most vessels were found superior to the mylohyoid muscle in the canine area and beneath the muscle in the mental and second molar areas. The smallest median vertical distance from blood vessel to bone was in the canine area (14.5 mm), followed by the mental foramen area (15.5 mm) and the second premolar area (19 mm). The median horizontal distance of the vessels from the lingual plate was 2 mm at the canine and second molar areas and 4 mm at the mental area. DISCUSSION: Lingual plate perforation, especially anterior to the canine area, can easily injure blood vessels in the floor of the mouth and cause life-threatening hemorrhage following implant placement. Bleeding can occur when the mandibular lingual plate is perforated. Care should be taken to recognize situations where this complication may occur. CONCLUSIONS: Based on the study of human cadavers, it appears that vessels in the floor of the mouth are sometimes in close proximity to the site of implant placement. Caution should be exercised when placing implants in this area.     

A case of IgD myeloma with extraosseous spread to the gingiva

A case of IgD myeloma at first diagnosed as Bence Jones type is reported. Multiple myeloma was diagnosed in the patient, a 39-year-old man with a tumor of the gingiva, because of the presence of multiple bone lesions with plasma cell proliferation and profuse urinary excretion of Bence Jones protein (lambda-type). An increase of serum IgD level (770 mg/dL) and a decrease in other classes of immunoglobulins were indicated by quantitative analysis; however, no apparent M-component was indicated by conventional electrophoresis on a cellulose acetate membrane. Microscopic examination of the specimen showed numerous atypical plasma cells. The disease profile of IgD myeloma, as well as the reasons IgD myeloma may be easily mistaken for Bence Jones type myeloma, is discussed.     

Epithelial-like cells in culture derived from human gingiva: response to nickel.

To obtain gingival cell cultures, human gingival tissue was minced and/or subjected to trypsin treatment with or without prior separation into epithelial and connective tissue portions. The tissues were then incubated in Eagle/Earle's MEM with 10% fetal calf serum in a humidified atmosphere of 5% CO2 in air. Fibroblast-like cell cultures were regularly obtained, and one culture showed epithelial-like cell islets that could be transferred and kept in continuous culture. These epithelial-like cells exhibited bone resorption stimulating activity as seen in gingival tissue and retained their growth pattern after prolonged storage. They were able to grow at serum concentrations down to 2.5% and with equal doubling time (about 17h) in rich or minimum essential media. Exposure to nickel gave toxic effects on the growth at concentrations down to 2.5 microgram/ml of nickel. In spite of the affinity of nickel to certain serum components, the serum concentration did not appear to be of specific importance to protect or aggravate the toxicity. It is felt that these cells may be of value for research on cytotoxicity of dental materials.     

Immunohistological study of neuronal markers in inflamed gingiva obtained from children with Down''s syndrome

The histological appearance of the gingiva in children with Down's syndrome (DS) was studied with special reference to inflammatory involvement and innervation. A dense infiltration of inflammatory cells was seen in the propria of most of the DS patients, including a few polymorphonuclear leucocytes. A hyperplasia of the epithelium was also found. The innervation of the gingiva was studied using immunohistochemistry. Nerve fibers as well as nerve bundles immunoreactive to neurofilament (NF) were seen in the propria, while occasionally intraepithelial NF fibers were observed. Calcitonin gene-related peptide (CGRP)-immunoreactive fibers and fiber bundles were also visualized, but they were less abundant than NF fibers. The density of NF and CGRP fibers and fiber bundles was estimated by semiquantitative evaluation. A higher density of NF and CGRP immunoreactive structures was observed in the propria of DS patients compared to the control subjects, while no obvious alteration was seen in their distribution in the propria. In addition, sparsely distributed fibers immunoreactive to peptide histidine isoleucine amide (PHI) and vasoactive intestinal polypeptide (VIP) fibers as well as neuropeptide Y (NPY) and tyrosine hydroxylase (TH) were seen, mainly surrounding blood vessels. A few substance P (SP) fibers were also found, mostly close to the epithelium. No obvious differences of these sparsely distributed fibers were seen in the DS patients compared to controls. Thus, a profound inflammatory involvement of the gingiva of DS patients is seen concomitant with a hyperinnervation of the presumed sensory component of the gingival innervation. In contrast, no alterations were seen in the density of neuronal markers related to autonomic nerve fibers. The sensory hyperinnervation observed is probably not specifically related to DS, but may be due to a sprouting of afferent nerves induced by the inflammatory reaction. However, factors released from the sensory afferents could contribute to the gingival inflammation seen in DS.     

Two cases of linear IgA disease with clinical manifestations limited to the gingiva

Linear IgA disease (LAD) is a chronic, subepithelial blistering disease that is associated with the presence of linear deposits of IgA along the basement membrane zone. Etiopathogenic aspects of LAD are only partially known. LAD is clinically characterized by vesiculobullous skin and mucous lesions. Although more than half of LAD patients present oral mucosal lesions, there are only a few cases reported of oral lesions as the only manifestation of LAD. This study presents 2 of these uncommon cases.     

Vascular leakage resulting from topical application of endotoxin to the gingiva of the beagle dog

Endotoxin from Leptotrichia buccalis was topically applied to tooth surfaces related to clinically healthy gingiva. Saline was used in contralateral controls. Vascular labelling with carbon black was used to indicate vascular leakage. All gingival areas where endotoxin was applied had labelled subcrevicular vessels (mean score of 3.4 on 0–4 scale). Minimal or no labelling was observed in control areas (score 0.9). The findings indicate that topical endotoxin causes leakage in vessels of healthy gingiva. It probably penetrates healthy crevicular epithelium to produce this effect and may be important as a participant in the early events of gingivitis.     

Continuous widening of the band of attached gingiva from 23 to 65 years of age

In earlier studies it was shown that the distance from the cemento-enamel junction to the mucogingival junction, i.e. the anatomical width of fibrously attached gingiva, increases significantly from 23 to 43 years of age. The aim of the present study was to examine whether alveolar growth continues to result in an increase in this dimension after the age of 43. In a total of 21 males aged 65.7 ± 9.1 years and 21 females aged 64.5 ± 6.1 years, with an average of 23 occluding teeth, the mucogingival junction was marked with short pieces of metal wire. Orthopantomograms were then taken and the distances measured from the mucogingival junction to the cemento-enamel junction and to the orthopantomographic projection of the bottom of the nasal cavity in the maxilla and from the mucogingival junction to the cementoenamel junction and to the lower border of the jaw in the mandible. The measurements were taken along the long axis of each occluding tooth. The bilaterally pooled results indicated that alveolar growth continues to increase the distance between the cemento-enamel junction and the mucogingival junction in both males and females from age 43 to 65 years. However, the growth was slower during this period than from age 23 to 43 years. The distance from the mandibular border to the mucogingival junction of the same jaw did not change from 23 to 65 years of age. In the maxilla, an increase in the distance from the floor of the nasal cavity to the mucogingival junction was indicative of a continuous growth through adult age of the basal bone in the male but not in the female cranium.     

Compromised inflammatory cytokine response to P. gingivalis LPS by fibroblasts from inflamed human gingiva

Clinical Oral Investigations - The aims of this study were to compare the in vitro cytokine response of gingival fibroblasts (GF’s) from healthy and inflamed human gingival tissues and to...