(29) Orofacial Granulomatosis Associated with Periodontitis and Local Etiologic Factors. A Case Report With 6.5 Year Followup

Introduction: Orofacial granulomatosis (OFG) is a granulomatous condition of the orofacial tissues. Signs and symptoms include swelling of the lips, erythema and swelling of the buccal mucosa, floor of the mouth and / or gingival tissues. Our patient presented with a history of swollen, erythematous, and shiny gingiva with spontaneous bleeding of two months duration. Review of medical history was non-contributory with the exception of her sister’s history of sarcoidosis. Our clinical differential diagnosis was hyperplastic gingivitis, foreign body gingivitis, plasma cell gingivitis, drug related gingival hyperplasia, and leukemia.

Methods: A gingival biopsy was performed and histologic examination gave a diagnosis of OFG. Clinical correlation to rule-out the possibility of a systemic granulomatous disease was required and the patient was referred to her physician. In the case presented here the OFG was limited to the gingival tissues and the main etiologic factor appears to have been periodontitis and concomitant heavy deposits of plaque and subgingival calculus. The patient was treated with full mouth scaling and root planing under local anesthesia and she received oral hygiene instruction. She has been
compliant with a recall/maintenance program every three months.

Results: Resolution of the granulomatous inflammation occurred with periodontal treatment and has remained stable during 6.5 years of follow up. The patient's medical evaluation for a systemic granulomatous disease was negative.

Conclusions: The patient's heavy deposits of plaque and appear to the triggering factor for the OFG.
Documentation includes intraoral photographs, photomicrographs, periodontal chartings, and radiographs over a 6.5 year period.

Lead Author's Contributions to the Research Project. : The Lead Author is the treating periodontist who initially examined the patient, requested an oral pathology consult, obtained the tissue for biopsy, performed the periodontal therapy and who has continued to see the patient on a three month recall schedule. The Lead Author also wrote the abstract and will be the presenter.