Erythematous gingival lesions in a teenage patient: a case report

Background

A sixteen-year-old male was referred to the Department of Child Dental Health at University Dental Hospital of Manchester regarding erythematous lesions on the buccal gingivae. These lesions had been present for approximately eighteen months without any changes in shape or size. The patient was asymptomatic with no relevant medical history. No known cause for the lesions had been identified.

Presentation

The patient presented with a caries-free permanent dentition and two discrete, erythematous lesions involving the marginal and attached gingivae above the upper lateral incisors (UR2 and UL2). The lesions were 6x4mm and 5x3mm in size above the UR2 and UL2 respectively without any induration or ulceration. The gingival appearance was felt to be desquamative and plaque-induced gingival inflammation was also noted. Basic Periodontal Examination revealed code 1 in all sextants, apart from the lower anterior sextant which scored a code 2. There was no trismus or palpable cervical lymphadenopathy. Differential diagnoses included spongiotic gingival hyperplasia and fibrous epulis.

Management

Initial management included tailored oral hygiene advice and professional mechanical plaque removal to aid resolution of gingival inflammation. The lesions persisted despite improved plaque control and an incisional biopsy of the lesion above UR2 was subsequently undertaken under local anaesthetic without any complications. The patient is due to attend for a review of the biopsy site and histopathological results, which will guide further management.

Discussion

Management of oral mucosal disease in children and young people requires a systematic approach. Clinical presentations can vary and patient management may necessitate input from multiple specialities including Oral Medicine and Oral Surgery. In this case, the patient was successfully treated under local anaesthesia alone but patient cooperation in this cohort can be challenging. Management must be tailored to the needs of the individual patient and undertaken in a timely manner for optimal outcomes.