Sweet syndrome is a relatively rare disease characterized by neutrophilia, tender and erythematous skin lesions with sudden onset of fever. Oral involvement is usually rare. We report a case of a 5-year-old boy who presented with fever, spontaneous erythematous swelling over the right periorbital and suprasternal region, upper left lip swelling, generalized gingival hyperplasia over the upper gingiva, and a single ulcer on the right soft palate region. Blood results was consistent with bicytopenia and leukocytosis, while biopsy of the skin and gingival lesions revealed dense infiltration of mixed inflammatory cells composed predominantly of neutrophils. Sweet syndrome was suggested based on the clinical presentations and histological features. Steroid treatment was initiated according to the suggested protocol; unfortunately, the child's condition started to deteriorate 3 weeks after his initial presentation, and he passed away 2 weeks later due to massive intracranial bleeding. Proper investigation and screening are crucial when any oral lesions with unknown causes are encountered.

Mucopolysaccharidosis type VI (MPS VI), a rare metabolic disorder, results from glycosaminoglycan accumulation in tissues, frequently leading to hyperplastic gingival alterations that necessitate comprehensive intervention. An 11-year-old male patient diagnosed with MPS VI required hospitalization due to complications associated with a ventriculoperitoneal shunt (VPS) valve. A dental evaluation identified bone malformation in the maxillomandibular complex accompanied by pronounced gingival hyperplasia. The surgical team performed a gingivoplasty in the operating room under general anesthesia, employing a combined technique involving manual scalpels and a diode laser to excise hyperplastic gingival tissue and cauterize bleeding sites. The patient exhibited an uneventful postoperative recovery, with no hemorrhagic or infectious complications. The diode laser demonstrated safety and efficacy in removing gingival tissue in this patient with MPS VI, facilitating local tissue repair, enhancing the aesthetic and functional profile, and ultimately improving the patient's oral health and quality of life.

Gingival enlargement is commonly seen during orthodontic treatment, specifically in individuals with fixed appliances. Its clinical significance stems from its multifactorial etiology. The purpose of this narrative review is to evaluate the available evidence related to the causes, influential components, symptomatic profiles, and therapeutic approaches to gingival enlargement during orthodontic treatment. An electronic literature research was carried out in PubMed without any limitations. A total of 10 studies were chosen, incorporating one randomized clinical trial and nine observational studies, including cross-sectional descriptive, histological, clinical observational, clinical and histological, and case report studies. The selected articles were focused on gingival alterations in individuals with either fixed or removable orthodontic devices. Then, the determinations were synthesized narratively and thematically. The outcomes propose that multiple factors are associated with gingival enlargement. Fixed orthodontic appliances are associated with an increased risk of gingival enlargement and may influence immune-mediated responses, resulting in thickened epithelium and proliferation of connective tissue, as demonstrated by histological findings. The overall therapy time, the type of device, and local irritants are considered influential factors. The treatment can be either conservative, such as improved dental health and the administration of antimicrobials, or invasive, including gingival excision or laser surgery. Laser therapy may be considered less invasive due to minimal hemorrhage and better recovery outcomes, although based on limited evidence. Gingival enlargement associated with orthodontic devices is a condition influenced by multiple factors, including microbial, mechanical, and substance-related factors. Even though inflammation can be reduced with minimally invasive treatments, surgical interventions are often essential in ongoing cases. Additional longitudinal research is essential to explain the etiology and strengthen prophylactic and healing approaches. The objective of this narrative review was to evaluate existing information on gingival enlargement associated with orthodontic appliances, with a particular focus on the underlying mechanisms, clinical consequences, and therapeutic strategies.

Verruciform xanthoma (VX) is a rare, reactive oral mucosal lesion that can mimic other papillary or verrucous hyperplastic conditions. The present report is of a gingival VX that clinically resembled other papillary lesions. A 14-year-old male reported a painless papillary lesion on the gingiva between the left mandibular central and lateral incisors, accompanied by erythematous anterior gingival margins. Based on clinical presentation, a provisional diagnosis of inflammatory gingival hyperplasia was considered. An excisional biopsy was performed, and histopathological examination revealed a hyperkeratotic, proliferative surface epithelium with elongated rete ridges and papillary projections filled with numerous foam cells, confirming the final diagnosis of VX. The patient has remained under follow-up for 1 year with no evidence of recurrence. The present case highlights the importance of recognizing VX as a distinct entity in the diagnosis of oral papillary lesions. It discusses possible etiopathogenic factors associated with gingival involvement in adolescents.

Background/Objectives: Chronic kidney disease (CKD) is associated with numerous oral manifestations that may negatively affect quality of life, nutrition, and overall health. This narrative review aimed to summarize current evidence regarding oral manifestations of CKD and kidney transplantation, examine their proposed underlying mechanisms, and discuss implications for dental management. Methods: A structured literature search of PubMed/MEDLINE was conducted for English-language publications from January 2000 to March 2026. Original studies, systematic reviews, meta-analyses, clinical guidelines, and relevant narrative reviews were included. Additional references were identified through manual screening of bibliographies. Results: Oral manifestations associated with CKD include xerostomia, periodontal disease, oral infections, anemia-related mucosal pallor, developmental enamel defects, and medication-related gingival overgrowth. Kidney transplant recipients are additionally at risk of opportunistic infections and oral malignancies related to long-term immunosuppressive therapy. While oral diseases, particularly periodontal disease and oral infections, may contribute to systemic inflammation, much of the available evidence remains observational. Similarly, many recommendations for dental management are based on expert consensus and clinical experience rather than high-quality interventional studies. Conclusions: Oral complications are common throughout the CKD continuum and warrant regular assessment and preventive care. Multidisciplinary collaboration is essential, while further prospective studies are needed to strengthen the evidence base for clinical management.

Fibromatous epulis of periodontal ligament origin (FEPLO), also known as peripheral odontogenic fibroma (POF), is a benign gingival lesion that occurs frequently in dogs. Common use of both names is cumbersome and confusing yet persists due to disagreement regarding pathogenesis. With the objective of clarifying the histogenesis and pathogenesis, 100 canine FEPLO/POF lesions that had been surgically excised en bloc were evaluated histologically to characterize the lesion's relationship to surrounding anatomic structures and to document concurrent pathologies in those tissues. No lesions involved the periodontal ligament space, although 88/100 (88%) lesions attached to alveolar bone, similar to the normal anatomy of the gingival ligament. The lesions consist of fibrous tissue with osteogenic potential, and 54/100 (54%) lesions had bone or cemento-osseous matrix. Odontogenic epithelium was evident in 63/100 (63%) lesions, and the paradental location of the epithelium suggests that the origin of most odontogenic epithelium in FEPLO/POF lesions is a result of hyperplastic junctional epithelium extending into the lesion. Hypercellularity was interpreted as a feature of reactive lesions since 15/17 (88%) hypercellular lesions were ulcerated and 15/17 (88%) were inflamed. Frequent concurrent histologic findings included hypercementosis at the cementoenamel junction of the adjacent tooth (79/89, 89%), reactive alveolar bone (90/100, 90%), and inflammation of alveolar bone (67/100, 67%). While the pathogenesis cannot be determined with absolute certainty, available evidence supports a reactive, hyperplastic process rather than neoplastic. The authors believe that fibromatous hyperplasia of the gingival ligament is an anatomically correct name that accurately reflects the likely etiopathogenesis.

Wegener granulomatosis (WG) is an autoimmune disease characterized by necrotizing granulomatous inflammation primarily affecting the respiratory tract and kidneys. Although head and neck involvement is common, oral manifestations presenting as strawberry gingivitis are rare and have seldom been reported as the initial presentation of WG. We report the case of a 17-year-old female who presented with recurrent gingival hyperplasia, initially misdiagnosed as squamous cell carcinoma based on histopathologic findings. However, imaging studies revealed no evidence of malignancy, prompting further diagnostic evaluation. Careful review of the laboratory and histopathologic findings ultimately led to the diagnosis of WG. Subsequent treatment with prednisolone led to partial resolution of the lesions. This case highlights the importance of considering WG in the differential diagnosis of atypical oral lesions to avoid misdiagnosis and ensure appropriate treatment.

Primary mucocutaneous tuberculosis of the lower lip, without pulmonary or systemic involvement, is an uncommon presentation of cutaneous tuberculosis. The rare combination of lower lip swelling, vermilion border beading, gingival hyperplasia and nasal crusting, as seen in our adolescent patient further adds to the atypical nature of the disease while also highlighting diagnostic complexity. We therefore urge dermatologists to keep a high index of clinical suspicion and undertake relevant investigations to actively rule out tuberculosis especially in endemic areas in cases of chronic non-healing lip lesions.

TAFRO syndrome is an infrequent and severe systemic inflammatory condition marked by thrombocytopenia, anasarca, fever, reticulin fibrosis/renal dysfunction, and organomegaly. Although tocilizumab has shown clinical efficacy in inducing initial disease control, evidence on sustained long-term remission beyond three years following anti-interleukin-6 therapy remains limited. We present a 46-year-old female who was admitted with worsening edema, gingival bleeding, and severe thrombocytopenia, initially misdiagnosed as idiopathic thrombocytopenic purpura with no clinical response. A comprehensive diagnostic workup demonstrated multisite serosal effusions (pleural fluid accumulation, pericardial fluid accumulation, and abdominal free fluid), enlarged cervical lymph nodes, grade 1-2 reticulin myelofibrosis with megakaryocytic hyperplasia, Castleman disease-like features on nodal histopathological examination, and increased serum interleukin-6 levels (19.2 pg/mL). The patient fulfilled all major and multiple minor diagnostic criteria for TAFRO syndrome. Treatment consisted of combination therapy with cyclophosphamide, corticosteroids, plasmapheresis, and tocilizumab administered biweekly for a total of eight doses. Complete resolution of thrombocytopenia, anemia, and inflammatory markers was observed after five cycles of tocilizumab. Comprehensive clinical, laboratory, and radiological surveillance showed sustained complete remission for more than three years, without evidence of disease relapse. This report highlights the potential role of tocilizumab-based therapy in achieving prolonged clinical remission in selected patients with TAFRO syndrome, particularly when interpreted within the overall clinical and laboratory context.

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.