Metastatic Tumors to the Gingiva and the Presence of Teeth as a Contributing Factor: A Literature Analysis

Background: Gingiva that is prone to inflammation may serve as a pre‐metastatic niche for the attraction of circulating malignant cells. The aim of this study is to analyze cases of metastatic lesions to the gingiva compared with cases metastasizing to other oral mucosal sites. The pathogenesis of gingival metastases is discussed, with emphasis on the role of inflammation. Methods: The English‐language literature between 1916 and 2011 was searched for cases of metastatic lesions to the oral mucosa; only cases metastasizing in the oral mucosa, gingiva, and periodontium were included. Results: Two hundred seven cases were included. The gingiva was the most common site (60.4%), followed by tongue and tonsil. The most common primary sites were lung (24.2%), kidney (13.5%), skin (10.6%), and breast (8.7%). In 27%, the oral lesion was the first sign of a malignant disease. In most cases, the lesion appeared as an exophytic mass (96%) diagnosed clinically as a reactive gingival lesion. The presence of teeth was significantly associated with the development of gingival metastases: in 108 of 125 gingival metastases, the lesion was found adjacent to teeth (P <0.001; odds ratio = 8.2). The average life expectancy after diagnosis of the metastasis was 3.7 months. Conclusions: The gingiva is the most common site for metastases to oral soft tissues, with strong association with the presence of teeth. This finding may be related to the role of inflammation in the attraction of metastatic cells to chronically inflamed gingiva.     

An unusual presentation of metastatic carcinoma involving the periodontium

A case of metastatic nasopharyngeal carcinoma involving the mandibular periodontium of a 36-year-old female is presented. The diffuse gingival enlargement from premolar to premolar was quite unusual, and other conditions were considered in the clinical differential diagnosis. Histopathologic evaluation of the gingival lesion showed a poorly differentiated carcinoma which appeared morphologically similar to earlier metastatic lesions of the nasal fossa and brain.     

Root resorption leading to linkage of dentinal collagen and gingival fibers?

A maxillary central incisor in a 55-year-old Caucasian female was extracted in modified block as part of a histologic study of gingival responses to subgingival crown placement. The facial portion of this block showed preclinical pocket depth of 1.0 mm with moderate gingival inflammation. The block was extracted 2 weeks after crown placement and prepared for histologic evaluation. Histologic responses to subgingival crown placement were, among others: gingival recession (1.0 mm), reformation of crevicular depth (0.7 mm) and remodelling of the gingival and periodontal attachment apparatus. Histologic evaluations of the gingival unit using cellular and connective tissue stains revealed an area of root resorption immediately apical to the junctional epithelium at a portion of the facial surface. Root resorption had progressed into dentin. Gingival connective tissue abutted the dentinal surface. Collagen stains showed the presence of tufts of collagen fibrils which appeared to arise from the dentin. These fibrillar elements seemed to splice with collagen fibrils found in the gingival connective tissue. The specimen thus suggests the possibility of a fiber linkage attachment involving exposed dentinal fibers as part of gingival repair following injury.     

牙周干预对环孢菌素A相关牙龈增生的预防效果观察

目的评价肾移植术前牙周基础治疗对环孢菌素A相关的牙龈增生的预防效果。方法选取即将行肾移植术且拟用环孢菌素A作为免疫抑制剂的患者20名,随机分为牙周干预组（A组）和对照组（B组）,在平衡了年龄、性别等干扰因素的前提下,记录被研究者移植术前及术后3个月、6个月、12个月时的牙周指标。结果两组的牙周指标在肾移植术前比较差异无统计学意义（P〉0.05）;在观察期间,我们发现A组的PLI、SBI、PD指数在3、6、12个月与0个月比较有所下降,且差异有统计学意义（P〈0.05）,GHI指数随着时间推移均数有所升高,但各时间点之间差异并无统计学意义（P〉0.05）;B组的PLI、SBI、PD、GHI逐渐升高,且差异均有统计学意义（P〈0.05）。结论牙周感染可能是肾移植术后环孢菌素A相关的牙龈增生的原因之一,术前进行牙周基础治疗对环孢菌素A相关的牙龈增生的发生有一定的预防作用。     

A variation from classic oral manifestations associated with acute myeloblastic leukemia. A case report

A case representing previously misdiagnosed acute myeloblastic leukemia associated with an absence of classical intraoral manifestations is presented. Platelet count was less than 15,000, and hematocrit was 20.3, yet clinical signs were limited to malaise and extreme gingival and mucosal pallor. The typical initial signs of gingival enlargement or hemorrhage never appeared, probably due to excellent plaque control by this patient. Mucosal color changes dictated the need for laboratory studies leading to a rapid and relatively early diagnosis.     

Necrotizing ulcerative gingival lesions and clinical attachment loss

This paper describes the association between the occurrence of necrotizing ulcerative gingival lesions and clinical attachment loss using multivariable logistic regression methods and data originating in an epidemiological study conducted among a random sample of adolescents (n = 9203). Results show that the presence of necrotizing ulcerative gingival lesions is strongly associated with the occurrence of clinical attachment loss, whether defined as the presence of clinical attachment loss > or= 1 mm in at least two teeth or as the presence of clinical attachment loss > or = 3 mm in at least one tooth. This contribution of necrotizing ulcerative gingival lesions appeared to occur independently of the contribution from known common risk factors. Our findings suggest that there are causes of necrotizing ulcerative gingival lesions, yet to be identified, which have a substantial impact on the occurrence of clinical attachment loss.     

Nitrendipine-induced gingival overgrowth in dogs

This study assessed the development of gingival overgrowth in dogs given nitrendipine, a new antihypertensive dihydropyridine. Nine male Beagle dogs with established plaque and gingivitis were used. Following a baseline examination, which involved assessment of plaque, gingivitis, and gingival enlargement, six dogs (test) received nitrendipine twice daily in a high dose, while 3 dogs (control) received placebo. Clinical scorings were repeated after 10 and 20 weeks. At termination of the study gingival biopsies were excised and examined morphometrically. Already at the 10-week examination definite changes in gingival size had occurred, and following 20 weeks of nitrendipine treatment the gingival enlargement had markedly increased. In none of the control dogs were there any signs of gingival size changes. The histopathological examination showed that the only principal changes in histopathological morphology were that areas of non-infiltrated connective tissue in test specimens showed an increase in vascularity and appeared more loose compared with the dense tissue in control specimens. The morphometric analysis demonstrated minor differences between test and control specimens in regard to all tissue fractions observed; however, such differences were numerically very small, and were not considered biologically significant. Thus, the results demonstrated that nitrendipine administered to Beagle dogs during a 20-week period causes marked overgrowth of gingival tissue of apparently normal composition. The fact that cases of gingival overgrowth have been reported among patients receiving other dihydropyridines suggest that the observed gingival overgrowth is an effect of this class of drugs.     

Functional characterization of human gingival lymphocytes

Lymphoid cells were isolated from human gingival tissues which were indexed clinically as normal, periodontal inflammation without pocket formation, and periodontitis or inflammation with pocket formation. These isolated gingival inflammatory cells were then assessed for their ability to kill gingival fibroblasts in vitro and to produce lymphotoxin without in vitro stimulation. Lymphocytes isolated from clinically normal gingival tissues showed no cytotoxic activity and did not produce significant amounts of lymphotoxin. Conversely, cells from inflamed tissues with no pocket were cytotoxic at a low level for gingival fibroblasts and produced some lymphotoxin. Cells isolated from periodontitis tissues (inflamed with pocket) showed a greater degree of cytotoxicity for the fibroblasts. and the activity increased with increasing numbers of lymphoid cells. These cells appeared to be very active. since a ratio of one lymphocyte per fibroblast still showed significant killing. In addition, lymphotoxin was elaborated by these periodontitis lymphocytes in culture. These data indicated that a local hyperimmune response was present in chronically inflammed gingiva and that the lymphoid cells were activated and had the potential for tissue destruction.     

Collagenolytic activity of crevicular fluid and of adjacent gingival tissue.

The fluid in and gingival tissue lining periodontal pockets were collected from male patients undergoing periodontal therapy. The collagenolytic activity of the crevicular fluid, and the ability of the gingiva in culture to degrade (a) an exogenous collagen substrate, and (b) endogenous collagen newly synthesized and labeled with H3-hydroxyproline, were related to the severity of gingival inflammation. Although inflammation appeared to have only a slight effect on gingival collagenolytic activity and on the turnover of collagen newly synthesized in culture, a marked effect was observed on the collagenase activity in the crevicular fluid. This study suggests that the collagen destructive activity of the periodontal lesion can be assessed by monitoring crevicular fluid collagenolytic activity.     

The structure of subgingival plaque in a beagle dog

The maxillary canines and second and third premolar teeth, together with supporting bone and gingival tissues, were surgically removed from a nine month old Beagle dog. All the gingival units showed clinical signs of gingivitis. At the orifice of the gingival crevice the plaque comprised a dense, mixed bacterial population. Within the crevice spirochaetes were first observed in association with other Gram-negative bacteria, but more apically they appeared to be the only organisms present. Coronally the spirochaetes were aligned parallel to one another and at right angles to the tooth surface. More apically the spirochaetes were loosely arranged and randomly orientated within a finely granular material. Occasionally spirochaetes were seen within the widened intercellular spaces of the superficial layers of sulcular epithelium. Beyond the spirochaete zone the attachment of the junctional epithelium to the enamel had been destroyed. It is suggested that the characteristic distribution and arrangement of spirochaetes within the gingival crevice is related to the growth requirements of these organisms.     

伴牙槽嵴吸收的牙周炎患者上前牙龈乳头缺陷程度影响因素初探

目的:探讨有牙槽嵴吸收时上前牙不同程度龈乳头缺陷的相关影响因素。方法:选择2019年6至12月就诊于北京大学口腔医学院·口腔医院牙周科,且经治疗后牙周炎控制稳定并定期进行牙周维护的14例牙周炎患者的64个上前牙龈乳头,通过标准化临床图像及锥形束CT影像资料综合分析,评价邻接触点至骨嵴顶的距离（distance from...     

Effects of mandibular orthognathic treatment on mucogingival tissues

Twenty-four patients receiving comprehensive orthognathic care including genioplasty were studied to evaluate the effect of orthognathic treatment on the mucogingival complex in the mandibular anterior region. Parameters measured prior to and after therapy were: width of keratinized gingiva, width of attached gingiva and gingival recession. A subjective assessment of tissue thickness was accomplished. A statistically significant decrease in width of both keratinized and attached gingiva was noted following orthognathic therapy in the mandibular anterior area. In six of 24 patients, gingival recession was a clinically significant finding. The actual pretreatment width of keratinized and/or attached tissue did not seem to be the critical factor in development of recession. Risk of recession appeared to increase when genioplasty was combined with mandibular advancement and tended to occur at sites in which the keratinized gingiva and underlying bone appeared thin.     

Distribution of fibronectin in healthy, inflamed and drug-induced gingival hyperplasia

The distribution of fibronectin (FN) in the healthy, inflamed and hyperplastic human gingiva was investigated by indirect immunofluorescence. FN appeared as a fibrillar structure in the lamina propria of the healthy gingivae. In the inflamed specimens, FN demonstrated parallel fibres, especially in the coronal areas of the tissue. In the phenytoin gingival overgrowth, tissue FN was observed as thin fibres with variable length. The thin fibres gave the appearance of penetrating the basement membrane of the epithelium. Cyclosporin A gingival enlargement could be differentiated by phenytoin lesions because of the higher length and the parallel distribution of the FN. Finally, FN was observed in the nifedipine gingival overgrowth, where a microfibrillar delicate network gave the appearance of a "cloud"-pattern of distribution. In all of the specimens, blood vessels and nerves could not be stained. These findings show that FN distribution could differentiate the structure of the gingival lesions.     

Involvement of HMGB1 and RAGE in IL-1β-induced gingival inflammation

ObjectiveExtracellularly released high mobility group box 1 (HMGB1) protein behaves as a cytokine, promotes inflammation and participates in the pathogenesis of several disorders in peripheral organs. The role of HMGB1 and receptor for advanced glycation end products (RAGE) expressed in gingival inflammatory tissues was explored.MethodsReal time PCR was applied to assay HMGB1 and RAGE mRNA expression in gingival epithelial and fibroblast cells induced by interleukin-1β (IL-1β). A highly selective inhibitor of inducible nitric oxide (iNOS) was employed. ELISA was done for measurement of HMGB1 concentrations in cell culture media of gingival epithelial and fibroblast cells. Immunohistochemistry was performed to analyse the expression and sub-cellular localization of HMGB1, together with RAGE, in specimens obtained from patients with chronic inflammation.ResultsA time-dependent response of HMGB1 and RAGE expression in gingival cells to IL-1β induction was observed. IL-1β promotes HMGB1 production in human gingival epithelial cells in a nitric oxide-dependent manner. HMGB1 and RAGE appeared highly expressed in gingival inflammatory tissues.ConclusionThese results demonstrate that HMGB1 and RAGE are abundantly expressed in gingiva and promptly released during gingival inflammation. We suggest a role for HMGB1/RAGE/iNOS signalling on inflamed gingival epithelial cells.     

Tissue reaction involving an intraoral skin graft and CP titanium abutments: a clinical report

Focal areas of gingival hyperplasia surrounding the transmucosal portions of titanium implants have been attributed to poor hygiene, lack of attached gingival tissues, and titanium allergy. Following mandibular vestibuloplasty and placement of a split-thickness skin graft, two of five patients developed persistent proliferation of the epithelial tissue surrounding endosseous CP titanium dental implants. In both circumstances, traditional gingivectomy procedures, chemotherapeutic agents, and aggressive oral hygiene measures failed to adequately control the hyperplastic response. Following replacement of the titanium abutments with custom-fabricated gold abutments, the epithelial condition appeared to return to normal.     

Puberty-associated gingivitis

In a 2-yr follow-up study gingival condition was related to oral hygiene and different stages of puberty in 88 14-yr-old Finnish schoolchildren. Visible plaque and gingival bleeding after probing were determined from six teeth, at four sites each. Bitewing radiographs were taken from the molar areas. These examinations were repeated 2 yr later. The pubertal stage of the subjects was determined at the age of 14 by the school physician based on the classification of Tanner according to breast development (M) in girls and genital development (G) in boys. All subjects were in the somatic period of puberty at the time of the baseline examination. No radiographically detectable bone loss was found in either of the examinations. There was no difference in the gingival bleeding tendency at various pubertal stages when all subjects were included or when boys and girls were compared separately. Instead, a highly significant correlation was found between gingival bleeding and visible plaque, both at the baseline and 2 yr later. The results indicate that from the age of 14 to 16 the influence of oral hygiene on the gingival condition may be more important than that of the rising level of steroid hormones.     

环孢素A诱导牙龈增生动物模型的建立及其病理学表现

目的:建立环孢素A(CyclosporinACsA)诱导的牙龈增生小鼠动物模型,观察其病理学表现,并进行组织测量,确定其可靠性。方法:将CsA溶于橄榄油中,按 30mgCsA/kg体重 /d胃饲远交群ICR雄性小鼠,分别在给药 2、4、6、8周时,随机取实验组小鼠下颌前部标本,体视显微镜下测量其下颌前牙龈体积;制作切片,光镜下观察其牙龈病理表现,并利用图象分析系统测量舌侧牙龈缘上皮厚度。结果:小鼠经胃饲 30mg/kg体重 /d的CsA,①4周后,肉眼见部分下颌前牙舌侧牙龈球形肥大;②体视显微镜下牙龈体积测量显示下颌前牙舌侧牙龈 4周至 8周明显增大(P<0. 01);③此时光镜下开始出现明显的牙龈增生病理表现:上皮增厚,上皮钉突明显且变宽,牙龈结缔组织增厚,基质和成纤维细胞增生,血管扩张等。④龈缘上皮厚度测量 2周时上皮增厚(P<0. 01), 4周增厚更明显(P<0. 001),持续至 8周。结论:胃饲小鼠CsA可诱导牙龈增生,其病理表现与其他动物模型和临床病理一致,该模型有一定可靠性,可用于进一步研究CsA诱导的牙龈增生的发病机理。     

Multiple gingival metastases from angiosarcoma of the breast

Metastases to the jaws and oral soft tissue occur rarely. Such metastases may result in the presenting symptoms and signs of malignant disease or may develop during the course of a previously diagnosed malignant condition. A case of multiple gingival metastases in a patient with angiosarcoma of the breast is reported.     

Oral lesions indicative of plasminogen deficiency (hypoplasminogenemia)

BACKGROUND: Gingival overgrowth with ulceration has recently been recorded in 4 reports: (1) our report of a British patient with ligneous conjunctivitis in whom the gingival lesions appeared to be related to tranexamic acid-an antifibrinolytic agent; (2) a report of 2 Turkish patients and an Italian patient with mainly gingival lesions; (3) our report of 5 Turkish patients with mainly gingival lesions; and (4) a report of 3 new Turkish cases, which also were associated with gingival lesions and alveolar bone loss. These patients all had gingival swellings, and a minority had conjunctival involvement similar to ligneous conjunctivitis, although the etiology was unclear in all. Nevertheless, fibrin exudation was fundamental because the hyaline or amyloidaceous material seen on the gingival biopsy stained for fibrin but failed to stain for amyloid. METHODS: We have examined 6 more patients who exhibited gingival swelling caused by amyloidaceous deposits that stained only for fibrin, and we assayed their plasminogen levels. RESULTS: The plasminogen functional activity assayed in these 6 additional patients, and in 2 of the 5 patients previously reported by us, was significantly reduced. CONCLUSIONS: Gingival overgrowth with ulceration appears to be a new complication caused by plasminogen deficiency; it also appears to be related to ligneous conjunctivitis in some cases.