Title: Multifactorial management of pediatric orofacial Granulomatosis: Associations with periodontal pathogens and allergic predisposition
Abstract:
Background: Orofacial granulomatosis (OFG) is a chronic granulomatous disorder affecting the oral and maxillofacial region, and its etiology remains unclear. Allergic predisposition and odontogenic infection have been suggested as contributing factors; however, the clinical significance of bacterial involvement in pediatric OFG has not been fully elucidated.
Objective: To evaluate the clinical characteristics and treatment outcomes of pediatric OFG patients managed using a multifactorial therapeutic approach targeting both bacterial and allergic factors.
Methods: We retrospectively reviewed 10 pediatric patients with histologically confirmed OFG treated at Tokyo Dental College Ichikawa General Hospital. Clinical findings, oral hygiene status, allergy history, periodontal pathogen profiles, and treatment responses were analyzed. Oral hygiene was assessed using the O’Leary Plaque Control Record (PCR). Subgingival plaque samples were analyzed using quantitative real-time polymerase chain reaction to detect periodontal pathogens, including Red complex bacteria, Fusobacterium nucleatum, and Aggregatibacter actinomycetemcomitans. Management included professional oral care, oral hygiene instruction, gingivectomy, antimicrobial therapy, anti-allergic agents, corticosteroids, and topical tacrolimus when indicated.
Results: The patients ranged in age from 6 to 17 years. The lower lip was the most frequently affected site. Eruptive gingivitis during mixed dentition was observed in 8 of 10 patients, and oral hygiene was generally poor. Relatively high levels of Fusobacterium nucleatum were identified in multiple cases, with co-detection of Tannerella forsythia in several patients. Clinical improvement was observed in all patients following individualized combined therapy. A representative adolescent case demonstrated recurrent disease associated with poor oral hygiene and symptom improvement following gingivectomy, antimicrobial therapy, and immunomodulatory treatment. Sustained remission was achieved after comprehensive management targeting both bacterial and allergic factors.
Conclusions: This pediatric OFG case series suggests that OFG may involve multifactorial mechanisms associated with allergic predisposition and periodontal dysbiosis. Multidisciplinary management focusing on oral hygiene, bacterial control, and immunological factors may contribute to favorable long-term outcomes, particularly during the tooth eruption period.
