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      Focal Reactive lesions of the Gingiva: An Analysis of 314 cases at a tertiary Health Institution in Nigeria

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          Abstract

          Background:

          The aim of this study was to review the clinicopathologic features of focal reactive gingival lesions at the Lagos University Teaching Hospital, Nigeria.

          Methods:

          A retrospective review of cases of different focal reactive gingival lesions from the records of the Departments of the Oral Biology/Oral Pathology and Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital between 1970 and 2008 was carried out. Available clinical data regarding age, gender, location, estimated duration of the lesion and treatment modality were obtained and analyzed.

          Results:

          Prevalence rate of focal reactive gingival lesions was 5.6%. Pyogenic granuloma (PG) was the most common lesions constituting 57% of the cases. Seventeen (9.5%) of the 179 cases of PG were pregnancy induced pyogenic granuloma. The female-to-male ratio was 1.7:1. All the 4 lesions occurred more in female patients than males. The mean age of patients at presentation was 30 ± 16.5 years. The lesions were commonly seen in the second and third decade of life and least commonly seen above the age of 60 years. The lesions were equally distributed on the maxillary and mandibular gingivae, and were mostly located on the buccal gingival of the jaws. Most (51.6%) of the lesions occurred in incisors/canine region. Recurrence of the lesions was seen in 9 cases (2.9%), all pyogenic granuloma.

          Conclusion:

          Focal reactive gingival lesions are relatively uncommon lesions of the oral cavity with a prevalence rate of 5.6%. The lesions occurred commonly in females, and in third decades of life. Pyogenic granuloma was the most common lesions constituting 57% of all cases.

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          Most cited references38

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          Oral pyogenic granuloma: a review.

          Pyogenic granuloma is one of the inflammatory hyperplasias seen in the oral cavity. This term is a misnomer because the lesion is unrelated to infection and in reality arises in response to various stimuli such as low-grade local irritation, traumatic injury or hormonal factors. It predominantly occurs in the second decade of life in young females, possibly because of the vascular effects of female hormones. Clinically, oral pyogenic granuloma is a smooth or lobulated exophytic lesion manifesting as small, red erythematous papules on a pedunculated or sometimes sessile base, which is usually hemorrhagic. The surface ranges from pink to red to purple, depending on the age of the lesion. Although excisional surgery is the treatment of choice for it, some other treatment protocols such as the use of Nd:YAG laser, flash lamp pulsed dye laser, cryosurgery, intralesional injection of ethanol or corticosteroid and sodium tetradecyl sulfate sclerotherapy have been proposed. Because of the high frequency of pyogenic granuloma in the oral cavity, especially during pregnancy, and necessity for proper diagnosis and treatment, a complete review of published information and investigations about this lesion, in addition to knowledge about new approaches for its treatment is presented.
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            Reactive lesions of the gingiva. A clinicopathological study of 741 cases.

            A series of 741 consecutive cases of localized hyperplastic lesions of the gingiva were studied. The lesions were reclassified into four groups: pyogenic granuloma, peripheral giant cell granuloma, fibrous hyperplasia and peripheral fibroma with calcification. This study indicates that there are some differences between these groups in age and sex distribution as well as in location and size of the lesion. Fibrous hyperplasia was the most common type, followed in descending order by pyogenic granuloma, peripheral fibroma with calcification and peripheral giant cell granuloma. The peripheral giant cell granuloma showed no sex predilection while fibrous hyperplasia, pyogenic granuloma and peripheral fibroma with calcification were more common in females. Pyogenic granuloma and peripheral fibroma with calcification occur in younger patients more often than fibrous hyperplasia, and thus may represent a stage in the development of fibrous hyperplasia.
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              Regulatory roles of sex hormones in cutaneous biology and immunology.

              Recent studies have revealed that sex hormones manifest a variety of biological and immunological effects in the skin. Pregnancy, menstruation and the menopause modulate the natural course of psoriasis, indicating a female hormone-induced regulation of skin inflammation. Estrogen in vitro down-regulates the production of the neutrophil, type 1 T cell and macrophage-attracting chemokines, CXCL8, CXCL10, CCL5, by keratinocytes, and suppresses IL-12 production and antigen-presenting capacity while enhancing anti-inflammatory IL-10 production by dendritic cells. These data indicate that estrogen may attenuate inflammation in psoriatic lesions. Estrogen, alone or together with progesterone, prevents or reverses skin atrophy, dryness and wrinkles associated with chronological or photo-aging. Estrogen and progesterone stimulate proliferation of keratinocytes while estrogen suppresses apoptosis and thus prevents epidermal atrophy. Estrogen also enhances collagen synthesis, and estrogen and progesterone suppress collagenolysis by reducing matrix metalloproteinase activity in fibroblasts, thereby maintaining skin thickness. Estrogen maintains skin moisture by increasing acid mucopolysaccharide or hyaluronic acid levels in the dermis. Progesterone increases sebum secretion. Estrogen accelerates cutaneous wound healing stimulating NGF production in macrophages, GM-CSF production in keratinocytes and bFGF and TGF-beta1 production in fibroblasts, leading to the enhancement of wound re-innervation, re-epithelialization and granulation tissue formation. In contrast, androgens prolong inflammation, reduce deposition of extracellular matrix in wounds, and reduce the rate of wound healing. Estrogen enhances VEGF production in macrophages, an effect that is antagonized by androgens and which may be related to the development of granuloma pyogenicum during pregnancy. These regulatory effects of sex steroids may be manipulated as therapeutic or prophylactic measures in psoriasis, aging, chronic wounds or granuloma pyogenicum.
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                Author and article information

                Journal
                Niger Med J
                NMJ
                Nigerian Medical Journal : Journal of the Nigeria Medical Association
                Medknow Publications Pvt Ltd (India )
                0300-1652
                2229-774X
                Jan-Mar 2011
                : 52
                : 1
                : 35-40
                Affiliations
                [1 ]Department of Oral Pathology and Biology, Faculty of Dental Sciences, College of Medicine, University of Lagos
                [2 ]Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Medicine, University of Lagos
                Author notes
                Correspondence to: Dr. O. A. Effiom, Dept. of Oral Pathology and Biology, Faculty of Dental Sciences, College of Medicine, University of Lagos E-mail: lanreadeyemo@ 123456yahoo.com
                Article
                NMJ-52-35
                3180751
                21968923
                de3a220b-bb3e-462b-b501-094435fa8d0d
                Copyright: © Nigerian Medical Journal

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Categories
                Original Article

                Medicine
                reactive,gingiva,focal,lesions
                Medicine
                reactive, gingiva, focal, lesions

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