Arteriovenous malformations (AVMs) are high-flow congenital vascular anomalies characterized by abnormal direct communication between arteries and veins, bypassing the capillary bed. Gingival enlargement or gingival overgrowth is a common gingival disease characterized by an increase in the size of the gingival tissues. The main factors of gingival enlargement are inflammation, drugs, systemic conditions or diseases, neoplastic or false enlargements, and local factors, such as plaque, calculus, and/or overhanging restorations. The purpose of this article is to present an interesting case of the management of a patient with mandibular gingival enlargement occurring in association with an underlying AVM.  A 24-year-old non-smoker female patient presented to the periodontal clinic for the evaluation of a gingival overgrowth on the right side of the mandible that had developed over a four-week period, following a referral from her vascular specialist. Patient was previously diagnosed with an intraosseous AVMs in jaws (j-AVMs). Her medical history consisted of undergone embolization therapy for the j-AVM one year before. Clinical evaluation revealed an asymptomatic, soft-consistency, red/purple tumor-like mass with a broad base, measuring 0.5 x 0.5 cm. The surrounding gingival tissues in the right mandibular region appeared hyperplastic and edematous. A diagnosis of generalized gingivitis was established. The region of AVM was topographically associated with the vascular lesion of the mandibular gingiva. The gingival hyperplasia was distinguished from the underlying AVM, clarifying that the two represented coexisting independent lesions. The coexistence of gingival overgrowth with an underlying intraosseous AVM is exceptionally uncommon and presents notable challenges in clinical management and treatment. This case highlights the importance of adopting a conservative and multidisciplinary management approach, particularly in patients with high-flow vascular anomalies, where invasive procedures may pose substantial risks. Effective management relies on close collaboration among dental clinicians, radiologists, and vascular specialists.

Drug-induced gingival overgrowth (DIGO) is a multifactorial adverse effect associated with calcium channel blockers and antiepileptic drugs, yet genetic susceptibility-particularly in Asian populations-remains poorly defined. We performed whole-genome sequencing in 74 Thai individuals, including 36 DIGO cases and 38 drug-exposed nonresponder controls. A genome-wide association study was conducted with adjustment for amlodipine exposure, which showed a significant association with DIGO. Complementary analyses included gene-based testing using Multi-marker Analysis of GenoMic Annotation, fine-mapping with Sum of Single Effects, haplotype analysis, and receiver operating characteristic-based risk modeling. Although no single nucleotide polymorphisms (SNPs) reached genome-wide significance, we identified 350 lead SNPs across 34 genes showing strong associations with DIGO (p < 0.001). After multiple-testing correction, six genes/SNPs remained statistically significant (p < 0.05), representing the most robust findings. Haplotype analysis implicated TTC7B, RWDD1, TOM1L1, C1QL2, and BBS1 as DIGO risk genes. These genes, not previously linked to DIGO, are involved in cellular trafficking, phosphoinositide signaling, ciliary function, and protein regulation. Our findings indicate that DIGO susceptibility is driven by genetically determined cellular response pathways in the presence of amlodipine rather than by pharmacokinetic mechanisms. The absence of associations with CYP2C9 and HLA variants previously reported in other populations highlights the importance of ethnically diverse pharmacogenomic studies.

Leukemia cutis is an uncommon extramedullary manifestation of acute myeloid leukemia (AML) caused by infiltration of the skin by leukemic blasts. Its clinical morphology is highly variable and may mimic infectious, inflammatory, or other neoplastic dermatoses, making tissue diagnosis essential. We report a 49-year-old man who presented with fever, epistaxis, and multifocal nodular and ulcerated skin lesions involving the right wrist, chest, and scalp, as well as gingival hyperplasia. Skin biopsy was reported to confirm cutaneous myeloid sarcoma, consistent with leukemia cutis in the setting of AML. Histopathology demonstrated dense dermal infiltration by atypical myeloid cells with relative epidermal sparing. The patient was diagnosed with AML with cutaneous involvement and was started on systemic chemotherapy. This case emphasizes the importance of early biopsy of suspicious skin lesions in patients with known or suspected hematologic malignancy and highlights the adverse prognostic implications of leukemia cutis.

Vitamin C, also known as ascorbic acid, plays a pivotal role in forming blood vessels, cartilage, muscles, and collagen in bones. We report a 6-year-old non-verbal female with global developmental delay who presented with complaints of lower limb pain and inability to bear weight. Symptoms started five weeks prior to presentation and had progressed from decreased activity to complete loss of weight-bearing. Physical examination showed gingival hyperplasia, perifollicular petechiae, lower limb edema, and corkscrew hair. Initial radiologic findings raised concerns of osteomyelitis, showing bone marrow edema, periosteal reaction, and cortical irregularity. However, correlation with dietary history limited to flavored milk and yogurt and lacking fruits and vegetables, in conjunction with clinical presentation, suggested vitamin C deficiency, and she was started on ascorbic acid. Vitamin C deficiency was later confirmed on day 7 by a low C deficiency level (<0.1 mg/dL). Treatment with ascorbic acid, multivitamins, and supportive therapy led to gradual recovery, and gastrostomy tube placement facilitated supplementation. This case highlights the importance of detailed dietary history and recognition of clinical signs of vitamin C deficiency. Early dietary assessment and clinical correlation can prevent unnecessary invasive procedures and prolonged antibiotic therapy. Early identification enables timely intervention, reducing morbidity and improving quality of life.

This narrative review describes the scientific evidence on drug-induced gingival overgrowth (DIGO) in kidney transplant patients treated with immunosuppressive agents, particularly Cyclosporine A, focusing on its prevalence, pathogenetic mechanisms, and clinical management strategies.

The aim of this study was to describe the clinical microscopic features of localized juvenile spongiotic gingival hyperplasia (LJSGH) using an operating microscope (OM), a non-invasive technique rarely applied to oral mucosal lesions. An 18-year-old female presented with asymptomatic gingival redness and bleeding affecting the buccal gingiva of previously orthodontically treated maxillary canines. Conventional clinical examination revealed gingival recession, erythema, and edema. OM evaluation enabled detailed visualization of gingival surface irregularities, superficial vascular spots, exudation, and friable tissue that bled upon touch and probing. An incisional biopsy was performed. Histopathological analysis showed acanthosis, spongiosis, exocytosis, congested capillaries at the epithelium-connective tissue interface, and a dense inflammatory infiltrate in the lamina propria, confirming the diagnosis of LJSGH. In conclusion, OM allowed the identification of vascularity, exudation, surface irregularity, and tissue friability, features not apparent in conventional clinical examination. These findings suggest that OM is a valuable adjunct for evaluating and documenting gingival lesions.

Oral infections remain highly prevalent among individuals with limited access to routine dental care. Blue light (BL) offers a promising alternative for managing these infections, but its efficiency is limited without BL-activated photosensitizers. Here, we engineered an ionizable liposome to encapsulate a newly identified BL-activated photosensitizer, p-toluquinone (p-TQ). The resultant p-TQ@Lipo responded to the acidic pH produced by bacteria, facilitating the targeted delivery of the cargo to the pathogens. p-TQ@Lipo had a pH-dependent surface potential change from +29.5 ± 2.1 mV at pH=5, to +8.2 ± 0.1 mV at pH=7, and -6.4 ± 0.5 mV at pH=8. When combined with 405 nm BL at a fluence as low as 27 J/cm[2], p-TQ@Lipo reduced bacterial load by >99%, with minimal cytotoxicity to human gingival fibroblasts, achieving a remarkable 359-fold improvement in selectivity over free p-TQ. Confocal microscopy validated more efficient delivery of the cargo to Gram-negative than to Gram-positive bacteria, reflecting differences in bacterial surface charges. We then established polymicrobial dental biofilms in vivo and in vitro, comprising BL-sensitive and -refractory and Gram-positive and -negative species. The polymicrobial biofilms were efficiently disrupted on ferret tooth surfaces in an ex vivo infection model and eradicated in an in vivo mouse oral infection model by repeated therapies of p-TQ@Lipo combined with BL, whereas either treatment alone was ineffective. Importantly, the treatment significantly decreased periodontal inflammation and hyperplasia. These findings establish p-TQ@Lipo plus BL as a safe and effective antimicrobial platform with translational potentials for oral infection management.