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 Table of Contents  
CASE REPORT
Year : 2012  |  Volume : 3  |  Issue : 6  |  Page : 182-184  

Plasma cell gingivitis - A rare case related to Colocasia (arbi) leaves


1 Department of Periodontics and Implantology, DAV (c) Dental College and Hospital, Yamunanagar (Haryana), India
2 Department of Periodontics and Implantology, Gian Sagar Dental College and Hospital, Ramnagar, Rajpura, Punjab, India
3 Department of Oral and Maxillofacial Surgery, MM College of dental Sciences and Research, Mullana, Ambala, Haryana, India

Date of Web Publication18-Sep-2012

Correspondence Address:
Deepika Bali
Department of Periodontics and Implantology, DAV (C) Dental College and Hospital, Yamunanagar, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-237X.101086

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   Abstract 

Plasma cell gingivitis is an uncommon inflammatory condition of uncertain etiology often flavoured chewing gum, spices, foods, candies, or dentifrices. The diagnosis of plasma cell gingivitis is based on comprehensive history taking, clinical examination, and appropriate diagnostic tests. Here we are presenting a rare case of plasma cell gingivitis caused by consumption of colocasia (arbi) leaves. Colocasia is a kind of vegetable, very commonly consumed in the regions of North India.

Keywords: Benign gingival condition, colocasia leaves, and plasma cells


How to cite this article:
Bali D, Gill S, Bali A. Plasma cell gingivitis - A rare case related to Colocasia (arbi) leaves. Contemp Clin Dent 2012;3, Suppl S2:182-4

How to cite this URL:
Bali D, Gill S, Bali A. Plasma cell gingivitis - A rare case related to Colocasia (arbi) leaves. Contemp Clin Dent [serial online] 2012 [cited 2019 Oct 22];3, Suppl S2:182-4. Available from: http://www.contempclindent.org/text.asp?2012/3/6/182/101086


   Introduction Top


Plasma cell gingivitis (PCG) is a rare benign condition of the gingiva characterized by dense infiltrate of normal plasma cells separated into aggregates of collagen strands. [1] Plasma cell gingivitis is an uncommon inflammatory condition of uncertain etiology [2] often flavoured chewing gum, spices, foods, candies, or dentifrices. [3] Plasma cell gingivitis was first reported in early 1970s as plasmocytosis of the gingiva, idiopathic gingivostomatitis, plasma cell gingivostomatitis, atypical gingivostomatitis, and allergic gingivostomatitis. Clinically, these cases are limited to the oral cavity with symptoms of angular cheilitis, erythematous gingivitis and glossitis although one case was reported with laryngeal manifestation. [4]

The diagnosis requires haematological screening in addition to clinical and histopathological examination. Pathologic changes are clinically similar to those of leukaemia, HIV infection, discoid lupus erythematosis, atrophic lichen planus, desquamative gingivitis, cicatricial pemphigoid which must be differentiated through hematologic and serologic testing. [5],[6]

Once the diagnosis of plasma cell gingivitis is made, it is still imperative to identify the antigen source of the inflammation.

A case of plasma cell gingivitis is presented here, in which the identification of the etiological agent was elusive.


   Case Report Top


A female patient of age 48 years reported to Department of Periodontology and Oral Implantology of D.A.V (c) Dental College and Hospital, Yamunanagar (India) with chief complaint of swelling of gums in front region from last 6 months. Clinically, the patient presented with severe inflammation of the gingival tissues from the free gingival margin to the mucogingival junction in maxillary anteriors and premolars. Heavy plaque accumulations were present all around the teeth. The gingiva bled with the slightest provocation. There was negative Nikolsky sign and no evidence of any cutaneous lesions. There was no evidence of ulceration or, of a vesicular eruption. The patient exhibited moderate loss of periodontal attachment in maxillary anteriors [Figure 1].
Figure 1: Pre-operative picture with gingival inflammation

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The only positive finding was that patient had consumed colocacia leaves in her meals. After the consumption of these leaves, she had started developing all signs and symptoms.

Blood investigation was done to rule out leukaemia or any other blood dyscrasias. The complete blood count investigations were normal and patient presented no relevant medical history.

A provisional diagnosis of localised chronic periodontitis in maxillary anteriors with generalized diffuse gingivitis was made. Initial therapy included oral hygiene instructions, scaling and root planing. Patient was strictly advised for not consuming the leaves.

The removal of local factors did not resolve the condition even after 4 weeks. A decision was made to excise enlarged gingival tissue under local anaesthesia and excised tissue was given for biopsy with the written consent of the patient. Patient reported after 2 weeks and the healing was uneventful [Figure 2].
Figure 2: Post-operative picture after 2 weeks of treatment

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   Histopathological Examination Top


H/E stained section revealed stratified squamous epithelium. The epithelium showed severe thinning over connective tissue pegs. The underlying connective tissue was highly infiltrated with plasma cells which were present within strands of collagen [Figure 3] (×10), [Figure 4] (×40)].
Figure 3: Histopathological picture of the excised tissue (×10)

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Figure 4: Histopathological picture of the picture showing plasma cells (×40)

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Based on clinical features, histopathological features and history, a diagnosis of plasma cell gingivitis was made.


   Discussion Top


Plasma cell gingivitis is an uncommon condition. The etiology of plasma cell gingivitis is not clear but due to obvious presence of plasma cells, it appears as immunological reaction to allergens such as tooth paste, chewing gums, mint and certain food.

The patient mentioned in this case report about development of symptoms after consuming colocacia leaves in her diet. Therefore, there is always a need to explore patient's habit before diagnosis and treatment planing.

In this case, patient reported with diffuse reddening of maxillary gingiva (anteriors and premolars) with oedematous swelling, which did not improve after conventional periodontal therapy. The differential diagnosis with cutaneous disorders (Desquamative lesions) was eliminated because of negative Nikolsky sign. Haematologic examination excluded leukaemia and lupus erythematosis.

The diagnosis of plasma cell gingivitis was made on the basis of histopathological examination of the excised gingival tissue. The presence of a large number of plasma cells in the established lesion of chronic inflammatory periodontal disease can occasionally lead to difficulty in distinguishing this condition from more exotic plasma cell lesion affecting the gingiva. These include rare case of extra medullary plasmacytoma, plasmacytosis of gingiva, plasma cell gingivitis and plasma cell granuloma. [7],[8],[9] Failure of response to conventional periodontal treatment alone and remission of condition after elimination of exposure to etiologic agent colocasia leaves confirmed the diagnosis of plasma cell gingivitis.


   Conclusion Top


The diagnosis of plasma cell gingivitis is based on comprehensive history taking, clinical examination, and appropriate diagnostic tests. Histopathological examination is the key for differentiating plasma cell gingivitis from other mimicking lesions.

 
   References Top

1.Serio FG, Siegel MA, Slade BE. Plasma cell gingivitis of unusual origin, A case report. J Periodontol 1991;62:390-3.  Back to cited text no. 1
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2.Jadwat Y, Meyerov R, Lemmer J, Raubenheimer EJ, Feller L. Plasma Cell Gingivitis: does it exist? Report of a case and review of the literature. SADJ 2008;63:394-5.  Back to cited text no. 2
[PUBMED]    
3.Silvermen S Jr, Lozada F. An Epilogue to plasma cell gingivostomatitis (allergic gingivostomatitis). Oral Surg Oral Med Oral Pathol 1977;43:211-7.  Back to cited text no. 3
    
4.Regezi JA, Taylor CG, Spinelli FR Jr, Lucas RN. Allergic gingivostomatitis with laryngeal manifestations: Report of case. J Oral Surg 1972;30:373-7.  Back to cited text no. 4
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5.Hedin CA, Karpe B, Larsson A. Plasma cell gingivitis in children and adults. A clinical and histological description. Swed Dent J 1994;18:117-24.  Back to cited text no. 5
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6.Lamey PJ, Lewis MA, Rees TD, Fowler C, Binnie WH, Forsyth A. Sensitivity reaction to the cinnamonaldehyde component of tooth paste. Br Dent J 1990;168:115-8.  Back to cited text no. 6
[PUBMED]    
7.Kerr DA, Clatchy KD, Regezi JA. Idiopathic gingivostomatitis cheilitis, glossitis, gingivitis syndrome; Atypical gingivostomatitis, plasma cell gingivitis, plasmacytosis of gingiva. Oral Surg Oral Med Oral Pathol 1971;32:402-23.  Back to cited text no. 7
    
8.Palmer RM, Eveson JW. Plasma cell gingivitis Oral Surg Oral Med Oral Pathol 1981;51:187-9.  Back to cited text no. 8
    
9.Macleod RI, Ellis JE. Plasma Cell Gingivitis related to the use of herbal toothpaste. Br Dent J 1989;166:375-6.  Back to cited text no. 9
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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