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.

BACKGROUND Primary aldosteronism (PA) is the most common cause of endocrine-related secondary hypertension, accounting for up to 10% of hypertensive cases in specialized centers. It is associated with increased risks of cardiovascular events, target organ damage, and metabolic complications. However, PA is often underdiagnosed due to its subtle or atypical clinical manifestations. In particular, young patients presenting with severe or resistant hypertension should prompt a thorough evaluation for secondary causes. One of the most concerning but underrecognized consequences of PA is its potential association with vascular abnormalities, including aortic dissection, which can be fatal if not promptly addressed. CASE REPORT We present the case of a 36-year-old man who was admitted with poorly controlled hypertension and gingival hyperplasia. Imaging studies revealed a descending aortic dissection. Laboratory investigations showed persistent hypokalemia, suppressed plasma renin activity, and markedly elevated plasma aldosterone concentration, all indicative of PA. Contrast-enhanced abdominal computed tomography (CT) identified a hypodense mass in the right adrenal gland, consistent with an adrenal cortical adenoma. The patient underwent successful laparoscopic right adrenalectomy. Postoperatively, his blood pressure and serum potassium levels normalized, and symptoms of gingival hyperplasia improved significantly. CONCLUSIONS This case underscores the importance of early screening for secondary hypertension, especially in younger individuals with severe clinical presentations. PA can lead to life-threatening complications such as aortic dissection if left undiagnosed and untreated. Clinicians should maintain a high index of suspicion for PA in similar cases. Timely diagnosis and surgical intervention can significantly improve patient prognosis and prevent catastrophic vascular events.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign vascular proliferation, typically affecting the head and neck's subcutaneous tissue, with infrequent involvement of the oral mucosa. We report the case of a 30-year-old female patient on oral contraceptives who presented with a hyperplastic, reddish-purple, asymptomatic, and bleeding gingival lesion in the left maxillary gingiva. Clinical examination revealed a 10 mm periodontal pocket in the upper left permanent canine, with horizontal bone loss affecting the adjacent lateral incisor and canine. Blood analysis showed mild eosinophilia. An initial incisional biopsy suggested a chronic inflammatory process, but due to persistent lesion growth, histopathological revaluation confirmed ALHE. Management included contraceptive discontinuation, scaling and root planing, and intralesional corticosteroid therapy, resulting in complete remission within 14 days. This case highlights the importance of considering ALHE in the differential diagnosis of hyperplastic gingival lesions with periodontal involvement. Furthermore, conservative treatment may offer an effective alternative to surgical excision for intraoral ALHE. A review of cases of oral ALHE in the last 50 years is also provided.

Ask-Upmark kidney disease is a congenital renal malformation characterized by segmental hypoplasia, leading to progressive impairment of renal function and severe hypertension. It is a rare anomaly that presents with various complications. A 14-year-old boy diagnosed with Ask-Upmark kidney was referred for dental care. The patient presented with mouth breathing, unsatisfactory occlusion, and severe drug-induced gingival hyperplasia, which hindered speech, diet, and oral hygiene. Imaging revealed the presence of all permanent teeth, but with delayed eruption, oblique eruption pathways, and risk of impaction. Management included oral hygiene instructions, prophylaxis, and ulectomy to facilitate tooth eruption. This case highlights the oral manifestations associated with the management of Ask-Upmark kidney, specifically drug-induced gingival enlargement and eruption disturbances. It underscores the necessity of multidisciplinary treatment, including dentistry, to improve the quality of life for these patients.