Gingival and Alveolar Flashcards
Parulis
Soft tissue abscess
Can NOT diagnose with radiograph, this is a CLINICAL
diagnosis, NOT radiographic diagnosis
Due to odontogenic or gingival infection
◦ Can also be foreign body related
Yellowish/opalescent to red/pinkish white nodule with
purulence
Typically soft and tender to palpation
TX: Properly diagnose and then treat source of infection,
Antibiotics may be needed to achieve profound anesthesia
Long list of examples…
Parulis
Pyogenic Granuloma
Peripheral Ossifying Fibroma
Peripheral Giant Cell Granuloma
Irritation Fibroma
Squamous Cell Carcinoma
Kaposi’s Sarcoma
Metastatic Tumors
LGSH
Pericoronitis
Eruption Hematoma
Bony Sequestrum
Herniated Gingival Follicle
Pyogenic Granuloma
Reactive lesion that results due to irritation
Also, commonly referred to as Pregnancy Tumor
Can occur ANYWHERE in mouth, but gingiva is most common site
Sessile, red nodule that can be single or multilobular and bleeds easily
Soft and friable tissue that is nontender to palpation
Surface ulceration is common
TX: Surgical excision of lesion and try to address irritant if known,
excise down to periosteum.
Can reoccur up to 16% of the time
Diff Dx: Pulp Polyp, pregnancy tumor epulis granulomatosum, peripheral ossifying fibroma, central giant cell granuloma
Peripheral Ossifying Fibroma
Reactive lesion ONLY occurring on gingiva
Firm, pink to red nodule that begins at interdental papilla and typically
has ulcerated surface
Can cause tooth displacement, loosening of the teeth
Radiographically may have foci of dystrophic calcifications, can be soft
in newer lesion
Rise from the cells of the PDL or periosteum → almost exclusively
gingivally located
TX: Surgical excision, but must go down to periosteum
Can recur up to 16-20% of the time
Increased incidence in younger patients and females (3:2)
Spindly cellular fibrous stroma that forms bone/cementum
Peripheral Giant Cell Granuloma
Reactive lesion secondary to trauma or irritation
Gingival or alveolar mucosa nodule ONLY
Red to Purplish in color typically, may bleed
Sessile or pedunculated and ulcerative at times
MANDIBLE > Maxilla
◦ Can cause superficial bone resorption
Any age it can occur, but typically 40-60 yo
Female > Male
TX: Excision and remove irritant
Recur about 10% of the time
◦ Rare cases have central bony lesion with soft tissue extension
Peripheral Giant Cell Fibroma
Fibrous tumor that is NOT associated with chronic irritation
Distinct histologic features vs. fibroma
◦ Stellate fibroblasts, multinucleated
Sessile or pedunculated in nature
Occurs on gingiva, tongue and hard palate
Pink, smooth to stippled nodule, nontender
50% occur on gingiva (Mandible»_space; Maxilla)
YOUNGER patients, under 30 yo
Female > Male
TX: Surgical excision
Localized Juvenile Spongiotic Gingival Hyperplasia
Unique form of gingival hyperplasia / gingivitis in younger patients
◦ Can effect adults, “Juvenile” in wording is misleading
◦ Adults typically diagnosed with pyogenic granuloma in past, prior to new diagnosis/name
Average age around 11 years old
F>M, 2:1
Predominately Caucasian (75%+)
Anterior gingival area, Maxilla»_space; Mandible
Multifocal lesions may exists
Asymptomatic, papillary, red, vascular, friable and bleeds easily
Result of hormonally stimulated growth – Improved hygiene will typically not resolve lesion
Treatment: Unresponsive to improved oral hygiene
◦ Surgical excision, if possible, depends on location at free gingival margin or up onto attached gingiva
◦ Laser treatment and Clobetasol topical application (TID) for 2 weeks with non-excised lesion
Localized Juvenile Spongiotic Gingival Hyperplasia appearance
Papillary and spongiotic epithelium
Vascular tissue with intense inflammation
Typically bleeds easily, originates in sulcular and junctional epithelium
Mimics a pyogenic granuloma, but flatte
Desquamative Gingivitis
Describes the peeling off of the top layer(s) of the gingiva
May appear as gingivitis, but hygiene is typically good
The gingival tissue will lose the stippled appearance
Gingival tissue is friable and easily peels away with minimal trauma
Various causes:
◦ Gingival erosive lichen planus
◦ Mucous membrane pemphigoid (MMP)
◦ Pemphigus Vulgaris (PV)
◦ Crohn’s disease
◦ Linear IgA
◦ Plasma cell gingivitis
Pemphigus Vulgaris
Bullous type disease that can impact the oral cavity
Antibodies mediated the response to the disease
Characterized by acantholysis within the epithelium → IgG auto-antibodies
Extremely rare disorder, only impacts between 0.1 and 0.5 per 100,00 patients
Typically a result of certain medications
Can be virally induced (HSV-1: Herpes simplex virus)
Chemicals, like pesticides, can elicit reaction too
Treatment with steroids and other drugs
Goal is to stop body from reaction and then remove the auto-antibodies from the patient
Mucous Membrane Pemphigoid (MMP)
Bullous type disease that can impact the oral cavity
Sub-epithelial separation and deposition of Ig complexes
Occurs at the basement membrane of the mucosa
Commonly seen in older adults
Medications and excessive UV light typically trigger the auto-antibody immune response
Can spontaneously resolve or take years to heal and not recur.
Treatment involves the use of steroids
Pericoronitis
Bacterial or food/plaque impaction under operculum of erupting molar typically
Inflamed red nodule of gingival tissue overly the tooth
Can be exacerbated by occulsal trauma from opposing arch
TX: Remove excess gingival tissue, warm salt water rinse and irrigate area as
needed
Caution with forceful irrigation: in gingival or bony defect exists, improper
irrigation can lead to non-resolving or worsening pericoronitis
Bony Spicule or Eruption Sequestrum
Unresorbed alveolar bone that is pushed to surface
with erupting tooth
Can be associated with post extraction pain and
remnant of bone that did not remodel
Can be very painful
Either removed with LA/topical and pliers OR needs LA
and removal with rongeurs
Eruption sequestrum resemble a completely debonded
sealant and have negative impression of occlusal
surface
Herniated Dental Follicle
Dental follicle that erupts through gingiva
Appears as sessile projection that may bleed
Radiographically it is associated with erupting tooth, typically 1st
permanent molar
TX: Surgically excise if painful, will self resolve
