A case of ameloblastoma presenting as an exophytic gingival lesion

Ameloblastomas are predominantly benign, intra-osseous odontogenic tumors and mucosal involvement is a rare secondary phenomenon, occurring only after a long period of intra-osseous growth and bone expansion. A case is reported of an intra-osseous multicystic (solid) ameloblastoma which presented as an exophytic gingival lesion in the left mandibular third molar region. A classification of exophytic gingival lesions is presented and the clinical features and management of ameloblastomas discussed.     

Pemphigus vulgaris presenting as a gingival lesion. A case report

A 26-year-old hispanic male presented with a nonspecific gingival lesion initially presumed to be of infectious etiology. During continued follow-up over several weeks, the lesion evolved into one typical of desquamative gingivitis. Direct immunofluorescent testing and routine histopathology resulted in a diagnosis of pemphigus vulgaris, which was confirmed by indirect immunofluorescence. Although it is unusual for pemphigus vulgaris to present with the gingiva as the sole primary site of involvement, this case serves to enhance our awareness of the gingiva as a site at which systemic disease can be manifested.     

Changes of facial gingival dimensions in children

Abstract Facial gingival surfaces of maxillary and mandibular anterior teeth were monitored to evaluate changes of the width of the keratinized and attached gingiva. 96 children 6 to 12 years of age were examined 2 × with an interval of 2 years. Measurements included dental plaque, gingival inflammation, probing depth, and width of keratinized and attached gingiva. In addition, study models were used to determine the facial/lingual position of the teeth. The results of this report, evaluating well-aligned teeth only, showed that during the 2-year observation period, increases in widths of the facial keratinized and attached gingiva took place. Increases occurred for the various teeth regions examined, and for deciduous as well as permanent teeth. During transition from the deciduous to the permanent dentition, patterns of change were variable. The increase of gingival widths was greatest for sites with the smallest baseline width of attached gingiva, and smallest for sites with the greatest baseline width. It was concluded that in well-aligned teeth, a conservative, monitoring approach prior to a corrective, surgical intervention seems prudent in children of this age with a minimal zone or absence of attached gingiva.     

Multiple calcifying hyperplastic dental follicles: comparison with hyperplastic dental follicles

J Oral Pathol Med (2011) 40 : 243–249 Background: Multiple calcifying hyperplastic dental follicles (MCHDF) is a rare disorder that is characterized by multiple impacted teeth and enlarged dental follicles that include calcifications. The current lack of information characterizing MCHDF impedes clinicians from making prompt differential diagnoses. We describe five cases of MCHDF and analyze their clinical and histopathological features in an effort to compare MCHDF with hyperplastic dental follicles (HDF) of singly impacted teeth. Methods: Our five cases of MCHDF were examined and clinically/histologically compared with data from 50 singly impacted teeth with HDFs. Results: The five patients described in this study were all male. The pattern of impaction varied, but every second molar was impacted in all the patients. Alterations in the number of teeth, such as supernumerary or congenitally missing teeth were observed. Upon microscopic examination, most of the calcifications consisted of basophilic droplets that were fused to one another, and were surrounded by whirling spindle cells. Another type of calcification that was observed less frequently resembled woven bone. These features were consistent with three previously reported cases and observed in HDFs of 20 singly impacted teeth. While the average period of impaction and the time to reach some level of calcification in MCHDFs was shorter than in single calcifying HDFs, the calcification was more generalized in MCHDFs. Conclusions: This study indicates that MCHDF is a separate pathologic entity with exclusive male predilection and earlier calcifications, different to HDF. Further studies are needed to understand the etiology of MCHDFs to provide various options for treatment, and to clarify the mechanisms of eruption.     

Cyclosporine-induced gingival overgrowth in beagle dogs

Development of gingival overgrowth during daily long-term cyclosporine A treatment was studied in 2-yr-old beagles. Gingival enlargement developed in five of 12 dogs (42%), primarily in the mandibular anterior area. The earliest gingival changes occurred by 3 wk as an increase in the size of the interdental papillae. The lesions progressively became more severe, in some cases obscuring portions of teeth by wk 6. The redundant tissue exhibited an increase in connective tissue components and an inflammatory infiltrate primarily of plasma cells. Severity of the overgrowth varied in responding animals; both incidence and severity were related to the CSA concentration in blood. The mean CSA blood levels of responders were significantly greater than nonresponders at wk 3, 6 and 10. Since beagles develop gingival overgrowth similar to humans, they provide an excellent model to investigate the roles of local and systemic factors in the induction of gingival overgrowth.     

Histological evaluation of a tooth with hyperplastic pulpitis and periapical osteosclerosis

Histological examination was carried out in a case of hyperplastic pulpitis associated with periapical osteosclerosis.     

Role of keratinized gingiva for gingival health

Abstract The present study was carried out in the Beagle dog in order to determine if variations of the width of the zone of keratinized gingiva occur in the canine dentition, if the width alters during the development of destructive periodontitis and if, subsequent to surgical excision of the periodontal lesion, the regenerated gingival margin differs from that of a normal, noninflamed gingiva. Five dogs were used. A baseline examination comprised assessments of dental plaque, gingival conditions and width of the zone of keratinized gingiva. Cotton floss ligatures were placed around the teeth on the right side of the jaws and plaque was allowed to accumulate in order to induce periodontal tissue breakdown. After 150 days the inflamed periodontal tissues around the experimental teeth were removed surgically using a “gingivectomy” or a flap procedure. In the “gingivectomy” procedure the entire zone of the keratinized gingiva was excised whereas the main part of the keratinized tissue was maintained with the flap procedure. During a healing period of 120 days plaque control was carried out daily. On the left side of the jaws (control side) a careful toothcleaning program was performed during the entire observation period of 270 days. Clinical examinations of all control and experimental tooth units were repeated on days 150 and 270. Biopsies were sampled from both sides of the jaws on day 270. In histological sections the free gingival tissue was subjected to histometric assessments and a stereologic analysis based on a standardized morphometric point-counting procedure. In addition, the number of leukocytes residing within the junctional epithelium was determined. The results showed that in Beagle dogs the width of the keratinized gingiva (WKG), on the facial aspect of premolars and molars, varies between 2 and 6 mm. During a period of 270 days of careful plaque control, the WKG was maintained unaltered. In comparison, a phase of experimental periodontitis resulted in a substantial decrease of the WKG. Subsequent to the excision of the inflamed periodontal tissues, which in some cases included the entire zone of the keratinized gingiva, a new free gingival unit developed. In most respects the structural composition of this regenerated gingival unit was similar to that of a normal control unit. Furthermore, in the absence of plaque, the regenerated soft tissue was free from signs of inflammation independent of presence or absence or width of the keratinized zone.     

Assessment of gingival change using color photography

abstract Intraoral color photographs were taken during a survey on 140 pupils at a comprehensive school to test the consistency of color transparencies in recording gingival status. The method is described. The results demonstrate that color photographs taken at the time of clinical examination using a simple, standardized technique increase the accuracy and reliability of information recorded. The value of being able to assess, all at the same time, a series of color transparencies taken at the time of the clinical examinations in a longitudinal study, whether it be an epidemiology survey or a clinical trial, will be obvious. The ability to refer constantly to the baseline condition will protect examiners against all the current difficulties of applying criteria to conditions that, by their very nature, have no finite limits. In addition, examiners using photographs will be constantly reminded of their examination standards and will be less likely to depart from them.     

Assessment of gingival change using color photography

abstract Intraoral color photographs were taken during a survey on 140 pupils at a comprehensive school to test the consistency of color transparencies in recording gingival status. The method is described. The results demonstrate that color photographs taken at the time of clinical examination using a simple, standardized technique increase the accuracy and reliability of information recorded. The value of being able to assess, all at the same time, a series of color transparencies taken at the time of the clinical examinations in a longitudinal study, whether it be an epidemiology survey or a clinical trial, will be obvious. The ability to refer constantly to the baseline condition will protect examiners against all the current difficulties of applying criteria to conditions that, by their very nature, have no finite limits. In addition, examiners using photographs will be constantly reminded of their examination standards and will be less likely to depart from them.     

Relationship of "bleeding on probing" and "gingival index bleeding" as clinical parameters of gingival inflammation

Abstract Bleeding on probing (BOP) and the gingival index have been used to clinically characterize the degree of gingival inflammation. It is, however, unclear to what extent these parameters correlate to each other and to probing pocket depth (PD). The purpose of this clinical study was to evaluate the association between BOP and GI bleeding (scores of 2 and 3), as well as the relationship of these variables to PD, in a group of patients presenting with naturally-occurring gingivitis. Based on screening examinations of 125 subjects with at least 20 teeth, no more than 4 sites with PD over 6 mm, a BOP frequency of 30% or greater, and no systemic condition that would influence the inflammatory response, were selected. 2 weeks after screening they were examined at 6 sites per tooth for plaque index, GI, PD and BOP. A standardized pressure sensitive probe (Florida Probe) with 20 g probing force was used for BOP and PD measurements. In this population, means of 40.9% (S.E.= 1.36) BOP sites and 35.3% (S.E, = 1.81) GI bleeding sites per patient were found. A total of 20,008 sites ranging in PD up to 5.9 mm were evaluated; however, the majority of sites (19,723, 98.6%) presented with <4 mm PD. When sites were evaluated, BOP demonstrated a positive correlation with PD, whereas GI bleeding correlated with PH. For sites characterized by the absence of BOP as well as the absence of GI bleeding (scores 0 and 1), the highest % of agreement between the 2 indices (77.7%) was found in shallow sites (0.1–2 mm). In contrast, when sites presenting with both BOP and GI bleeding were analyzed, the highest % of agreement (85,4%) was found for sites with PD >4.0 mm. In this gingivitis population group, it appears that BOP and GI bleeding evaluate distinct inflammatory1 conditions of the gingival tissues, and the relationship between the 2 clinical parameters may vary according to PD at the individual site examined.     

Multiple calcifying hyperplastic dental follicles

Multiple calcifying hyperplastyic dental follicles is a rare condition characterized by multiple unerupted teeth with abundant calcifications and rests of odontogenic epithelium in their enlarged dental follicles. This article describes an additional example of this condition.     

切牙区牙龈颜色的测量与初步分析

目的：对健康汉族成人切牙区牙龈颜色的色度值进行采集和分析,研究人体切牙区牙龈色度学分布。方法：用MINOLTACS-321便携式色差仪采集、分析127例受试者切牙区牙龈色度值,采用SAS软件进行统计学分析。结果：上颌附着龈色度值范围L＊24．25-58．88、a＊1．72-18．64、b＊0．59—10．16;上颌边缘龈色度值范围L＊23．14-59．81、a＊1．42-16．52、b＊0．56-7．99;下颌边缘龈色度值范围L＊29．94-60．12、a＊1．54-13．74、b＊1．22—9．81。上颌附着龈和边缘龈无明度上的差异,但附着龈较边缘龈的牙龈颜色要偏红偏黄许多;下颌边缘龈较上颌边缘龈则明度高,牙龈颜色偏红偏黄。结论：通过此项研究,初步确定了健康汉族成人切牙区牙龈颜色在色空间的分布范围和分布特点。     

Longitudinal observation of "unattached," mobile gingival areas

Facial gingival surfaces over cuspids and bicuspids in 20 patients were monitored for 5 years to evaluate the importance of attached gingiva in the maintenance of a stable periodontium. 43 surfaces "at risk" were compared to 36 "non-risk" surfaces within these patients. Surfaces "at risk" had to meet the following 3 criteria as established by both of 2 independent examiners: width of keratinized gingiva less than or equal to 1.0 mm; absence of attached gingiva; mobility of the gingival margin. During the 5 years of observation, "non-risk" surfaces showed a trend toward decrease in mean width of keratinized gingiva, while this measurement remained unchanged for the surfaces "at risk" Probing depths remained unaltered for both groups. A trend toward gingival recession and loss of probing attachment was observed for both "risk" and "non-risk" surfaces. Thus, this study failed to demonstrate that "unattached" and mobile facial gingival surfaces are more susceptible to periodontal breakdown than "attached" surfaces.     

Patterns of cytokeratin expression in human gingival epithelia

Specimens of human gingiva were collected from teenage and adult subjects and frozen sections were stained with an extensive panel of monoclonal antibodies with defined specificities for individual cytokeratins. The results indicated different and distinctive patterns of keratin expression by the oral gingival, oral sulcular and the junctional epithelia. It was observed that epithelium with staining characteristics of sulcular epithelium extended over the gingival crest onto the oral surface of the gingiva. Junctional epithelium showed the unusual pattern of co-expression of keratins typical of the stratifying and of the simple epithelial phenotypes. The patterns of gingival keratin expression are compared with those of other mucosal epithelia. The findings are discussed in relation to mechanisms that may determine or influence the junctional epithelial phenotype.     

Tobacco smoking and gingival neutrophil activity in young adults

Abstract . The influence of smoking on the activity of the gingival neutrophils in young periodontally healthy adults was studied. The neutrophil activity was measured in terms of the gingival crevicular fluid (GCF) levels of elastase, lactoferrin (LF), a-1-antitrypsin (a-1-AT), α-2-macroglobulin (α-2 MG) and protein. 30 healthy dental students with no clinical signs of periodontitis, 15 smokers (8 women and 7 men) aged 20–32 years and 15 non-smokers (7 women and 8 men) aged 22–31 years, volunteered to take part in the investigation. The gingival inflammation was registered at 6 sites and the GCF volume was collected from the same sites. The GCF volume was measured with a Periotron 6000®. The elastase activity was measured with a chromogenic low molecular substrate and the LF, α-1-AT, α-2-MG levels were determined with ELISA. The protein concentration was measured by the Bradford method.The results showed a statistically significantly lower GCF volume among smokers as compared to non-smokers. No significant difference was found in the elastase activity/μl of the GCF supernatant between smokers and non-smokers but there was a large inter-individual variation. Nor did the concentrations of LF, α-1-AT, 7alpha;-2-MG and protein per μl GCF differ significantly between the 2 groups. The results suggest that the influence of smoking on the examined factors associated with neutrophil activity is limited under healthy or slightly inflamed gingival conditions giving only small amounts of GCF.     

嗜酸性粒细胞增生性淋巴肉芽肿的免疫研究进展

嗜酸性粒细胞增生性淋巴肉芽肿也称木村病(KD),伴有嗜酸性粒细胞和血清免疫球蛋白(Ig)E升高.低亲和力IgE受体表达于B细胞、T细胞、嗜酸性粒细胞表面,调节各种免疫应答.在KD初发和复发患者中,IgG4均增高,被看作非主要致病性抗体.滤泡树突细胞分泌的趋化因子、黏附分子和营养因子可调控B细胞免疫应答并作用于局部微环境.嗜酸性粒细胞分泌的嗜酸性粒细胞阳离子蛋白在KD发病过程中起着重要的作用.肥大细胞可促进嗜酸性粒细胞的浸润并诱导B细胞合成IgE.KD患者血清补体C5a高反应性可以调节补体活化后介导的细胞免疫应答.白细胞介素(IL)-4可诱导IgE合成,IL-5、粒细胞-巨噬细胞集落刺激因子和IL-3可促使嗜酸性粒细胞局灶浸润.嗜酸性粒细胞趋化因子与调节正常T细胞表达和分泌因子一起参与嗜酸性粒细胞在炎症处的聚集.Th细胞又分为Th1和Th2细胞,Th1细胞参与细胞免疫反应,Th2细胞参与体液免疫及变态反应性免疫反应.嗜酸性粒细胞增多及IgE升高,可能系Th2细胞在KD发病机制中起着重要的作用.     

Chorioepithelioma presenting as a bleeding gingival mass.

A case is reported in which a very malignant neoplasm appeared clinically to be a pregnancy tumor or a hemangioma. There was, of course, no question as to the cause of death in this particular case. It was of interest because of the rarity of the tumor, the metastasis to the oral cavity, and the fact that the final diagnosis was established from pathologic examination. The case demonstrates, with emphasis, the great importance of biopsy and routine pathologic examination of all tissue for accurate and correct diagnosis, regardless of its clinical appearance.     

3-year observations on gingival recession in mandibular incisors in children

28 children aged 6-13 years, with gingival recession localized to mandibular incisors, were monitored longitudinally to evaluate any changes of the labial periodontal tissues. Measurements included dental plaque, gingival inflammation, gingival recession, probing depth, probing attachment level, keratinized and attached gingiva. Following baseline examination, the incisors were observed at yearly intervals over 3 years. The results showed that a high level of oral hygiene was maintained and that gingival inflammation occurred only to a minor degree throughout the observation period. Gradual reductions in the amount of gingival recession and probing attachment levels took place in all children except for 1 of the subjects with 1 severely malpositioned tooth. Probing depths and widths of keratinized and attached gingiva remained relatively unchanged. The finding that gingival recession in mandibular incisors in young children often improves over time suggests that preventive or reparative treatment in this part of the developing dentition may not be necessary. Decisions about such treatment should be postponed until any spontaneous improvement has taken place.