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Plasma Cell Gingivitis

Plasma cell gingivitis (PCG) is a rare inflammatory disease of the gums, which is defined by plasma cell infiltration into subepithelial tissue. This benign condition is characterized by gingival erythema and edema. Although the etiology may be unknown, this is believed to be a hypersensitivity reaction in some cases.


Presentation

The clinical picture of PCG features gingival erythema and edema, which may expand to the mucogingival junction [1] [2] and even to the palate. The involved regions are the anterior maxillary and mandibular segments. The gums may be friable and hence prone to bleeding during chewing, brushing teeth or flossing.

Although rare, PCG may be accompanied by cheilitis [3], which is characterized by lip swelling, dryness, atrophy, and the formation of fissures. PCG may also be associated with glossitis, which is marked by tongue enlargement and erythema as well as the development of furrows and crenations.

Patients report mouth soreness and burning, which is exacerbated by consumption or usage of certain products. While the etiology has not been determined [3], it is strongly suggested that this condition arises from a hypersensitive reaction to allergens such as certain toothpaste ingredients, chewing gum, khat, cinnamon, or other spices [4] [5].

Complications

There is a case report describing a young adult with PCG who developed gingival enlargement and generalized aggressive periodontitis (GAP) [6]. However, it was unclear whether PCG or GAP occurred first.

Oral exam

Notable findings include red colored marginal and attached gingiva with swelling and diffuse enlargement [3]. There may be granule-like formations as well. If cheilitis is present, then the lip(s) will be dry, swollen, and fissured.

Sputum
  • The workup consists of a complete blood count (CBC), a complete biochemistry panel (CMP), erythrocyte sedimentation rate (ESR), thyroid function tests, HIV screening, acid-fast bacilli (AFB) sputum smear, and peripheral blood smear.[symptoma.com]
Sore Mouth
  • mouth can develop, and if so pain is sometimes made worse by toothpastes, or hot or spicy food. [7] The lesions can extend to involve the palate. [7] Plasma cell cheilitis appears as well defined, infiltrated, dark red plaque with a superficial lacquer[en.wikipedia.org]
Macroglossia
  • […] wart Tongue Ankyloglossia Black hairy tongue Caviar tongue Crenated tongue Cunnilingus tongue Fissured tongue Foliate papillitis Glossitis Geographic tongue Median rhomboid glossitis Transient lingual papillitis Glossoptosis Hypoglossia Lingual thyroid Macroglossia[en.wikipedia.org]
Microstomia
  • Sialolithiasis Sjögren's syndrome Orofacial soft tissues – Soft tissues around the mouth Actinomycosis Angioedema Basal cell carcinoma Cutaneous sinus of dental origin Cystic hygroma Gnathophyma Ludwig's angina Macrostomia Melkersson–Rosenthal syndrome Microstomia[en.wikipedia.org]
Microdontia
  • Dilaceration Discoloration Ectopic enamel Enamel hypocalcification Enamel hypoplasia Turner's hypoplasia Enamel pearl Fluorosis Fusion Gemination Hyperdontia Hypodontia Maxillary lateral incisor agenesis Impaction Wisdom tooth impaction Macrodontia Meth mouth Microdontia[en.wikipedia.org]
Ankylosis
  • Plasmoacanthoma Stomatitis Aphthous Denture-related Herpetic Smokeless tobacco keratosis Submucous fibrosis Ulceration Riga–Fede disease Verruca vulgaris Verruciform xanthoma White sponge nevus Teeth ( pulp, dentin, enamel ) Amelogenesis imperfecta Ankylosis[en.wikipedia.org]
Xanthelasma
  • […] spongiotic gingival hyperplasia, oral lesions associated with cosmetic fillers, oropharyngeal carcinomas related to human papillomavirus (HPV), IgG4-related disease and mammary analogue secretory carcinomas, Globodontia, Lobodontia, Leishmaniasis, and Xanthelasma[books.google.com]

Workup

During the clinical assessment of an individual with the above manifestations, the clinician should obtain a family history and a list of known allergens. Additionally, a detailed medical history is necessary to rule out differential diagnoses, which include leukemia, myeloma, HIV infection, and connective tissue diseases such as discoid lupus erythematosus, pemphigoid, and lichen planus [7] [8]. Furthermore, other diseases that should be excluded are tuberculosis, Crohn disease, and Wegener granulomatosis. The clinician must also determine whether the patient is using antiseizure medications that cause gingival hyperplasia, which includes phenytoin and phenobarbital [9] [10].

Another critical component of the evaluation is a thorough oral exam of the gums, teeth, mouth, tongue and lips. Additionally, a physical exam including inspection of the skin is important.

The workup consists of a complete blood count (CBC), a complete biochemistry panel (CMP), erythrocyte sedimentation rate (ESR), thyroid function tests, HIV screening, acid-fast bacilli (AFB) sputum smear, and peripheral blood smear [6]. Serology is done if needed. Biopsy of the affected tissue is also useful, especially if the condition is refractory to therapy. Allergen tests should be considered as well.

Histopathology

When a biopsy is taken, the histopathological analysis reveals the presence of diffuse plasma cell infiltration of the connective tissue. This finding confirms the diagnosis.

Human Papillomavirus
  • NEW cutting-edge content includes pathologies and conditions such as localized juvenile spongiotic gingival hyperplasia, oral lesions associated with cosmetic fillers, oropharyngeal carcinomas related to human papillomavirus (HPV), IgG4-related disease[books.google.com]

Treatment



Prognosis

  • […] includes a brief description of each individual lesion or pathologic condition and the kind of pathologic process that it represents, followed by a discussion of its clinical and/or radiographic presentation, histopathologic features, and its treatment and prognosis[books.google.com]
  • Its etiology, biological behavior, ideal treatment and prognosis are still unclear and rather controversial.[link.springer.com]
  • The line of treatment was extraction of the lower anteriors, as it had a poor periodontal prognosis. The patient was recalled for phase I therapy. In the next visit, the swelling was surgically excised and sent for biopsy.[jcdr.net]
  • Prognosis Partly due to the lack of understanding of this condition, feline lymphoplasmacytic gingivitis stomatitis complex is frustrating to treat. Many patients fail to respond to treatment, even after full mouth extraction.[en.wikivet.net]

Etiology

  • Abstract Plasma cell gingivitis is a benign lesion of unknown etiology characterized by massive and diffuse infiltration of plasma cells into the gingival connective tissue.[ncbi.nlm.nih.gov]
  • While the etiology has not been determined, it is strongly suggested that this condition arises from a hypersensitive reaction to allergens such as certain toothpaste ingredients, chewing gum, khat, cinnamon, or other spices.[symptoma.com]
  • The etiologic agent must be identified and the substance eliminated from use. This report outlines a case of plasma cell gingivitis which may have been brought on by the use of red peppers in cooking.[ncbi.nlm.nih.gov]
  • Abstract Plasma cell gingivitis is a rare benign condition of the gingiva of unknown etiology characterized by sharply demarcated erythematous and edematous gingiva often extending to the mucogingival junction.[ncbi.nlm.nih.gov]
  • Abstract Plasma cell gingivitis (PCG), an infrequent benign inflammatory condition of unknown etiology, is a type of plasma cell orificial mucositis, which includes a wide spectrum of conditions.[ncbi.nlm.nih.gov]

Epidemiology

  • […] namely, allergic, neoplastic and of unknown cause. [3] Treatment [ edit ] Preventing exposure to the causative antigen leads to resolution of the condition. [6] Tacrolimus or clobetasol propionate have also been used to treat plasma cell cheilitis. [5] Epidemiology[en.wikipedia.org]
  • Epidemiology Frequency United States Frequency is difficult to determine because of the lack of agreement on measurement criteria.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology The most common type of gingivitis involves the marginal gingiva and is brought on by the accumulation of microbial plaques in persons with inadequate oral hygiene.[emedicine.medscape.com]

Prevention

  • Advertisement American Journal of Preventive Medicine and Public Health SUBMIT YOUR ARTICLE NOW[scopemed.org]
  • Plasma cell gingivits has been subclassified into 3 types based upon the cause; namely, allergic, neoplastic and of unknown cause. [3] Treatment [ edit ] Preventing exposure to the causative antigen leads to resolution of the condition. [6] Tacrolimus[en.wikipedia.org]
  • Q: Can I prevent a hypersensitivity reaction from occurring? A: Maybe. The best way to prevent a hypersensitivity reaction is to avoid any agent that provokes it.[maaom.memberclicks.net]
  • Medical College, Agra, Uttar Pradesh, India 3 Department of Pedodontics and Preventive Dentistry, Azamghar Dental College, Azamghar, Uttar Pradesh, India 4 Department of Pedodontics and Preventive Dentistry, Career Post Graduate Institute of Dental Sciences[mjdrdypu.org]
  • J Indian Soc Pedod Prevent Dent - Supplement 2008. 39. Diagnosis 40.[slideshare.net]

Patient Information

References

Article

  1. Macleod RI, Ellis JE. Plasma cell gingivitis related to the use of herbal toothpaste. Br Dent J. 1989;166(10):375–6.
  2. Gargiulo AV, Ladone JA, Ladone PA, Toto PD. Case report: Plasma cell gingivitis A. CDS Rev. 1995; 88(3):22–3.
  3. Janam P, Nayar BR, Mohan R, Suchitra A. Plasma cell gingivitis associated with cheilitis open link: A diagnostic dilemma! J Indian Soc Periodontol. 2012; 16(1):115-9.
  4. Marker P, Krogdahl A. Plasma cell gingivitis apparently related to the use of khat: Report of a case. Br Dent J. 2002; 192(6):311–313.
  5. Al-Meshal IA. Effect of (alpha) chationone, an active principle of Catha edulis Forssk (khat) on plasma amino acid levels and other biochemical parameters in male wistar rats. Phytother Res. 1988; 2(2):63–66.
  6. Saluja TS, Satoskar S, Bandodkar S, Antao CJ. Plasma cell gingivitis with aggressive periodontitis: A rare presentation of an uncommon condition. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016; 2(2):94-97.
  7. Hedin CA, Karpe B, Larsson A. Plasma-cell gingivitis in children and adults. A clinical and histological description. Swed Dent J. 1994;18(4):117-24.
  8. Lamey PJ, Lewis MA, Rees TD, et al. Br Dent J. 1990; 168(3):115-8.
  9. Hassell T, O'Donnell J, Pearlman J, et al. Phenytoin induced gingival overgrowth in institutionalized epileptics. J Clin Periodontol. 1984;11(4):242–53.
  10. Cornacchio AL, Burneo JG, Aragon CE. The effects of antiepileptic drugs on oral health. J Can Dent Assoc. 2011; 77:b140.

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Last updated: 2018-06-22 00:20