Nitta H, Kameyama Y, Ishikawa I
Department of Periodontology, Faculty of Dentistry, Tokyo Medical and Dental University, Japan.
J Periodontol. 1993 Oct;64(10):1008-12. doi: 10.1902/jop.1993.64.10.1008.
A 15-year-old female patients suffered from recurrent unusual enlargement of the gingiva together with rapidly progressive alveolar bone loss. The enlarged gingiva completely covered her anterior teeth and protruded from the mouth. Marked inflammatory edematous tissue, which predominantly contained plasma cells, was observed in the connective tissue. Rapidly progressive alveolar bone loss was observed radiographically. The serum antibody titer to Porphyromonas gingivalis, measured by ELISA, was much higher than that in healthy individuals. The diagnosis was unusual gingival enlargement with rapidly progressive periodontitis. Conventional periodontal therapy, including plaque control, scaling, root planing, and surgical removal of the soft tissue, did not produce complete healing of the gingival lesion, although recurrence of gingival enlargement and further loss of the periodontal attachment level were well controlled. After the periodontal treatments, the serum antibody titer to P. gingivalis decreased to normal levels. This unusual gingival enlargement was considered due to systemic factors that exaggerated the gingival response to local irritation and altered the usual clinical features of chronic gingivitis; local plaque irritation produced the extensive and recurrent enlargement of the gingiva. Under these circumstances, infection or overgrowth of periodontopathic bacteria, including P. gingivalis, might occur and the alveolar bone loss would then advance very rapidly.
一名15岁女性患者反复出现牙龈异常肿大，并伴有快速进展的牙槽骨吸收。肿大的牙龈完全覆盖了她的前牙，并从口腔中突出。在结缔组织中观察到明显的炎症性水肿组织，主要包含浆细胞。影像学检查发现牙槽骨快速吸收。通过酶联免疫吸附测定（ELISA）检测，患者血清中牙龈卟啉单胞菌抗体滴度远高于健康个体。诊断为伴有快速进展性牙周炎的异常牙龈肿大。常规牙周治疗，包括菌斑控制、龈上洁治、根面平整以及手术切除软组织，虽能很好地控制牙龈肿大复发和牙周附着水平进一步丧失，但牙龈病变并未完全愈合。牙周治疗后，血清中牙龈卟啉单胞菌抗体滴度降至正常水平。这种异常牙龈肿大被认为是由于全身因素夸大了牙龈对局部刺激的反应，并改变了慢性牙龈炎的常见临床特征；局部菌斑刺激导致牙龈广泛且反复肿大。在这种情况下，包括牙龈卟啉单胞菌在内的牙周病原菌可能发生感染或过度生长，进而牙槽骨吸收会迅速进展。
