Title: A rare presentation of plasma cell gingivitis
Abstract:
A 77-year-old female patient was referred to the Oral Surgery department by her general dentist on the two-week-wait (2WW) pathway. She complained of soreness and swelling affecting the upper labial gingivae for the past 6 months. Her dentist had reported that the area was tender to palpation with an absence of bleeding, and no improvement was noted following treatment with antibiotics and antiseptic mouth rinse. In terms of her medical history, she had chronic obstructive pulmonary disease, angina and a history of breast cancer. Her medications included inhalers, GTN spray, aspirin, nicorandil and omeprazole. She had no known allergies and was a non-smoker. On examination, extra-oral assessment was unremarkable with no palpable lymphadenopathy. Intra-orally, there was red hyper-granulomatous swelling of the upper labial gingivae spanning UR3-UL3. Following clinical assessment, an urgent 2WW biopsy under local anaesthetic was arranged, in addition to clinical photography and blood tests (including full blood count, HbA1c, zinc, iron, and urea & electrolytes). Prescriptions for doxycycline and betamethasone mouth rinse were also provided.
An incisional punch biopsy revealed mucosa with extensive erosion and ulceration. Severe inflammation composed mainly of lymphocytes and plasma cells was appreciated in the stroma. Congested blood vessels were noted. There was no evidence of dysplasia or malignancy. Final histological diagnosis was of inflammatory changes. At the post-operative visit, inflammation of the upper labial gingivae persisted, and all remaining gingivae had a normal clinical appearance. The full blood count, HbA1c, and urea & electrolytes returned within normal ranges. Zinc and ferritin were slightly below the lower limit. An OPG ruled out dental pathology and a differential diagnosis of plasma cell gingivitis was then made. Plasma cell gingivitis (PCG) is a rare, benign gingival disease which is non-dental plaque-induced. It is associated with hypersensitivity reactions. Clinically, there are sharply demarcated erythematous gingivae with loss of stippling. Histopathology demonstrates sub-epithelial plasma cell proliferation. PCG commonly occurs in the maxillary anterior region, and unlike plaque-induced gingivitis can involve the complete width of attached gingiva up to the mucogingival junction. Given its potential to mimic conditions such as multiple myeloma and leukaemia, PCG requires careful assessment, accurate diagnosis, and exclusion of other inflammatory or plaque-induced gingival diseases through thorough clinical evaluation and investigation.
