Professional Oral Hygiene as a Therapeutic Option for Pediatric Patients With Plasma Cell Gingivitis: Preliminary Results of a Prospective Case SeriesJournal of Periodontology

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Authors
Paolo G. Arduino, Francesco D'Aiuto, Claudio Cavallito, Paola Carcieri, Mario Carbone, Davide Conrotto, Patrizia Defabianis, Roberto Broccoletti
Year
2011
DOI
10.1902/jop.2011.100663
Subject
Periodontics

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Text

Case Series

Professional Oral Hygiene as a

Therapeutic Option for Pediatric

Patients With Plasma Cell Gingivitis:

Preliminary Results of a Prospective

Case Series

Paolo G. Arduino,* Francesco D’Aiuto,† Claudio Cavallito,* Paola Carcieri,* Mario Carbone,*

Davide Conrotto,* Patrizia Defabianis,‡ and Roberto Broccoletti*

Background: Plasma cell gingivitis (PCG) is a rare, benign inflammatory condition of unclear etiology with no definitive standard of care ever reported to our knowledge. The aim of this case series is to ascertain the clinical efficacy of professional oral hygiene and periodontal therapy in younger individuals with a histologically confirmed diagnosis of PCG.

Methods: All patients received non-surgical periodontal therapy, including oral hygiene instructions, and thorough supragingival scaling and polishing with the removal of all deposits and staining combined with the use of antimicrobials in a 9-week cohort study. Clinical outcome variables were recorded at baseline and 4 weeks after the intervention and included, as periodontal parameters, full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), the clinical extension of gingival involvement, and patient-related outcomes (visual analog score of pain).

Results: A total of 11 patients (six males and five females; mean age: 11 – 0.86 years) were recruited. Four weeks after finishing the oral hygiene and periodontal therapy protocol, a statistically significant reduction was observed for FMPS (P = 0.000), FMBS (P = 0.000), reported pain (P = 0.003) and clinical gingival involvement (P = 0.003).

Conclusion: Standard, professional oral hygiene procedures and non-surgical periodontal therapy including antimicrobials were associated with a marked improvement of clinical and patient-related outcomes in pediatric cases of PCG. J

Periodontol 2011;82:1670-1675.

KEY WORDS

Antimicrobials; gingivitis; oral hygiene; plasma cell.

P lasma cell gingivitis (PCG) is a particularly unusual condition characterized by the diffuse infiltration of plasma cells into subepithelial tissues.1,2

This benign inflammatory condition is defined mainly by a dense, band-like plasmacytic infiltrate in the upper dermis.2-4

Clinically, PCG appears as a diffuse reddening and edematous swelling of the attached and free gingiva, with a sharp demarcation along the mucogingival junction. Ulcerations are rare features and are commonly asymptomatic, although some individuals may complain of pruritus, burning, or pain sensations.5

Although the exact etiologic factors are not known, flavoring agents, such as cinnamonaldehyde and cinnamon in chewing gums and some toothpastes were described as possible etiologic factors of PCG.6 The differential diagnosis of this rare condition is very important because of its similarity with some other aggressive conditions, such as malignancies, human immunodeficiency virus infection, and other forms of desquamative gingivitis.4,7,8

To the best of our knowledge, no definitive standard of oral care was defined for * Department of Biomedical Science and Human Oncology, Oral Medicine Section, Lingotto

Dental School, University of Turin, Turin, Italy. † Periodontology Unit, Division of Clinical Research, University College of London Eastman

Dental Institute, London, U.K. ‡ Department of Biomedical Sciences and Human Oncology, Section of Pediatric Dentistry,

Pedodontics, Traumatology, and Orofacial Malformations, University of Turin. doi: 10.1902/jop.2011.100663

Volume 82 • Number 12 1670

PCG. In addition, there is little evidence and no agreement on the most appropriate surgical or non-surgical periodontal protocols on PCG and long-term management. This disorder was reported to be non-plaque induced; however, effective dental plaque control was reported to reduce gingival inflammation.9,10 Therefore, the aim of this study is to estimate the effects of professional oral hygiene in young individuals diagnosed with PCG.

CASE DESCRIPTION AND RESULTS

Patients with PCG (age range: 7 to 17 years) were selected among individuals referred to the Unit of Pediatric Dentistry, University of Turin, Turin, Italy, with gingival disorders of unknown etiology from January 2008 to February 2010. All referrals were clinically examined by a group of experienced oral health care providers (PGA, MC, and PD) who recorded clinical aspects, sizes, and sites of oral involvementof lesionsand started the diagnostic procedures. All individuals were referred by their general dental practitioner with an enclosed set of standard radiographs which were used to exclude any signs of alveolar bone loss or other bone diseases.

A number of steps were undertaken to perform an accurate diagnosis of PCG.2,5,10 Briefly, because

PCG was suggested to be a potential allergic manifestation to flavorings, coloring agents, and additives, especially those included in toothpastes (i.e., Cinnamomun zeylanicum), all individuals examined were asked not to use any type of toothpaste, fizzy drinks, or chewing gum for 1 month. Four weeks after the first visit, a biopsy of the inflamed gingival tissue and a direct immunofluorescence analysis were carried out to confirm the diagnosis. Routine serologic analyses were also performed, including the quantification of serum vitamin B12, folic acid, iron (Fe++), and a full leukocyte blood count with standard laboratory procedures.

All cases had a microscopic dense accumulation of plasma cells in the gingival connective tissue with no cellular atypia present. Moreover, none of the cases presented granulomas in the subepithelial tissues.

Clonality was also studied due to the possibility of myeloma, but all samples showed that the plasma cells were polyclonal.

All eligible candidates for this study and their parents/guardians were informed about the experimental protocol and provided oral consent. The Ethics Review Board of the Lingotto Dental School, University of Turin, approved the study.

Case Series Design and Clinical Outcomes (Table 1)