Gingival enlargement as a manifestation of tuberous sclerosis: case report and periodontal management.
ABSTRACT Tuberous sclerosis is an autosomal-dominant inherited disease involving many organs of the body. Oral manifestations include gingival enlargement, fibromas, and dental enamel pitting. The report presents a case of tuberous sclerosis with gingival enlargement histologically consistent with angiofibroma, describes its successful periodontal management, and reviews the literature associated with oral manifestations of tuberous sclerosis.
A 26-year-old white male presented to the Department of Periodontics and Implant Dentistry, New York University College of Dentistry, with a diagnosis of tuberous sclerosis and a chief complaint of gingival enlargement affecting mastication and esthetics. Following a complete medical history review, consultation with the patient's medical team at New York University Medical Center, and a thorough oral and periodontal examination, a treatment plan was developed that included oral hygiene instructions, mechanical debridement, and periodontal reevaluation. This was followed by gingivectomy, which provided improved function and esthetics. Excised tissue was submitted for histologic examination. The patient was followed every 2 months for assessment of the outcome of the surgical treatment. An extensive search of the dental and dermatologic literature was performed on MEDLINE.
Histologic examination of the gingival tissue revealed features consistent with angiofibroma. Fifteen months following gingivectomy, the contours and gingival surface appearance remained normal.
The gingival enlargement was histologically consistent with the characteristic angiofibromas of tuberous sclerosis. The gingival enlargement responded very well to gingivectomy and periodontal maintenance.
Article: Tuberous sclerosis: a case report.[Show abstract] [Hide abstract]
ABSTRACT: Tuberous sclerosis is an inherited neurocutaneous disorder that occurs in approximately 1 in 7,500 live births. It is characterized by benign neoplasms of the skin, heart, kidneys, lungs, central nervous system, and mucosa. Oral lesions are usually fibrous in nature and most commonly occur on the anterior gingivae. Patients may suffer with epilepsy and learning difficulties, which may complicate dental management. When a 10-year-old girl with a history of tuberous sclerosis was brought in for a routine dental check-up, a leafy growth on the anterior gingiva was detected. An excisional biopsy was carried out. Histologically, the appearance was described as nonspecific, but was consistent with a diagnosis of tuberous sclerosis. Tuberous sclerosis is a rare condition that may exhibit oral manifestations. The patients may also exhibit epilepsy and learning difficulties. Dental management of affected patients may therefore be more complicated and complex.Special Care in Dentistry 01/1954; 30(4):157-9. DOI:10.1111/j.1754-4505.2010.00141.x
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ABSTRACT: In some pathological conditions, gingivitis caused by plaque accumulation can be more severe, with the result of an overgrowth. Nevertheless, the overgrowth involves the gingival margin with extension to the inter-dental papilla. The lesion may involve the inter-proximal spaces, and become so extensive that the teeth are displaced and their crowns covered. Severe overgrowth may lead to impairment in aesthetic and masticatory functions, requiring surgical excision of the excessive tissue. Aim of this study is to describe an operative protocol for the surgical treatment of localized gingival overgrowth analyzing the surgical technique, times and follow-up. A total of 20 patients were enrolled and underwent initial, non surgical, periodontal treatment and training sessions on home oral hygiene training. The treatment plan involved radical exeresis of the mass followed by positioning of an autograft of connective tissue and keratinized gingiva. During 10 years of follow-up, all the grafts appeared well vascularized, aesthetically satisfactory, and without relapse. Periodontal examinations, surgical procedures, and dental hygiene with follow-up are an essential part of the treatment protocol. However, additional effort is needed from the patient. Hopefully, the final treatment result makes it all worthwhile.Head & Face Medicine 08/2010; 6:19. DOI:10.1186/1746-160X-6-19 · 0.87 Impact Factor