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Tuberculous gingival enlargement: A rare clinical manifestation

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Journal name: Journal of Indian Society of Periodontology
Original article title: Tuberculous gingival enlargement: A rare clinical manifestation
The Journal of Indian Society of Periodontology (JISP) publishes original scientific articles on periodontology (the study of supporting structures of teeth) and oral implantology. It is a bimonthly open-access journal with special issues for specific occasions.
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Original source:

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Author:

Maria Subash Aaron Muthuraj, Arun Parappa Maradi, Srihari Janakiram, Koshy Chithresan


Journal of Indian Society of Periodontology:

(A bimonthly open-access journal)

Full text available for: Tuberculous gingival enlargement: A rare clinical manifestation

Year: 2017 | Doi: 10.4103/jisp.jisp_170

Copyright (license): CC BY-NC-SA


Summary of article contents:

Introduction

Tuberculosis (TB) is a chronic granulomatous disease primarily caused by Mycobacterium tuberculosis. Although the overall incidence of TB is declining, it remains a critical public health issue, particularly in developing countries. Oral manifestations of TB are uncommon, as most oral lesions are secondary to pulmonary infections. Primary oral TB typically affects younger adults with a preference for the tongue and gingiva. The rarity of primary oral TB lesions warrants detailed documentation, especially when systemic symptoms are absent, which can lead to misdiagnosis.

The Importance of Early Diagnosis of Gingival TB

A case was presented involving a 13-year-old boy with gingival enlargement and lower lip swelling, without systemic manifestations. His medical history included inadequately treated tuberculous lymphadenitis. The diagnostic process involved a provisional diagnosis of chronic inflammatory gingival enlargement; however, further tests, including histopathology, revealed noncaseating granulomas characteristic of tuberculous granuloma. The patient's elevated erythrocyte sedimentation rate (ESR) and previous history of TB underscored the need for prompt diagnosis. Antitubercular treatment was initiated, resulting in resolution of the lesions, reinforcing the need for dentists to consider TB in differential diagnoses of gingival enlargement.

Conclusion

This case underscores the critical need for early and accurate diagnosis of primary tuberculous gingival enlargement, which is often overlooked. A thorough medical history, along with hematological and histopathological assessments, can aid in distinguishing TB-related gingival conditions from other causes of gingival enlargement. The importance of recognizing TB in oral lesions emphasizes the collaborative role dentists play in managing and referring such cases, ultimately enhancing patient outcomes through timely intervention and appropriate treatment.

FAQ section (important questions/answers):

What is the primary cause of tuberculosis in the oral cavity?

Tuberculosis in the oral cavity is primarily caused by Mycobacterium tuberculosis, often originating from pulmonary TB. Gingival TB cases are rare and can be mistakenly diagnosed if not associated with systemic infections.

What were the key clinical features of the patient's case?

A 13-year-old boy presented with gingival enlargement and lower lip swelling, asymptomatic in nature. His history of inadequate treatment for tuberculous lymphadenitis was also vital in assessing his current condition.

How was the diagnosis of tuberculous gingival enlargement confirmed?

Diagnosis was confirmed through histopathological examination revealing noncaseating granulomas and Langhans giant cells. The patient's elevated erythrocyte sedimentation rate and previous TB history also supported the diagnosis.

What treatment was administered for the patient's condition?

The patient received a six-month course of antitubercular therapy, including rifampicin, ethambutol, isoniazid, and pyrazinamide, which led to significant improvement in gingival and lip swelling.

Why is early diagnosis of gingival tuberculosis important?

Early diagnosis is crucial as primary TB lesions in the gingiva may be misdiagnosed. Proper diagnosis aids in timely treatment, preventing complications and recurrence associated with inadequately treated TB.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “Tuberculous gingival enlargement: A rare clinical manifestation�. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.

1) Table:
Table refers to a structured arrangement of data in rows and columns. In this context, it might be used to summarize patient information or findings from studies related to tuberculosis and its effects on oral health, emphasizing data organization for clear understanding and communication among medical professionals.

2) Relative:
Relative means concerning or associated with something. In the context of tuberculosis, it may refer to the relationship of various symptoms or medical history elements that relate to diagnosing and understanding the disease, particularly in the case of individuals with a past history of tuberculosis.

3) Tuberculosis:
Tuberculosis (TB) is a prevalent infectious disease caused by Mycobacterium tuberculosis. It poses significant health challenges globally, especially in developing regions. TB can manifest in various forms, including oral lesions, which are vital to recognize for accurate diagnosis and treatment, showcasing the interplay between systemic and oral health.

4) Disease:
Disease indicates a pathological condition of a bodily part resulting from various causes, such as infection. Understanding disease in the context of tuberculosis is crucial, as it informs healthcare providers about diagnostic and treatment approaches necessary for managing infections that may present asymptomatically or in unusual forms.

5) Drug:
Drug refers to a substance used for medical treatment. In the case report, antitubercular drugs like rifampicin and isoniazid are highlighted, illustrating their importance in the management and treatment of tuberculosis, underscoring the need for effective pharmacological interventions in patient recovery and disease resolution.

6) Swelling:
Swelling denotes an increase in size or volume of affected body parts, commonly due to inflammation or infection. In the presented case, gingival swelling indicated an underlying issue, potentially tuberculosis, emphasizing the need for thorough examination and understanding of oral manifestations related to systemic diseases.

7) Account:
Account signifies a narrative or explanation of events. In medical literature, it refers to documenting patient histories, symptoms, and treatments, like the account of tuberculosis in this case. Accurate accounts are essential for establishing patterns, developing treatment protocols, and educating future practitioners about uncommon manifestations.

8) Hygiene (Hygienic):
Hygiene emphasizes cleanliness and practices that maintain health. In oral health care, poor hygiene can exacerbate conditions like gingival tuberculosis, illustrating the connection between oral hygiene practices and overall health. This highlights the necessity of promoting proper hygiene to prevent diseases and improve clinical outcomes.

9) Pur:
Poor indicates a lack or deficiency, often referring to health and wellness. The report mentions poor oral hygiene as a contributing factor in the development of gingival conditions. Recognizing such deficiencies is critical for healthcare practitioners when evaluating patients and formulating effective treatment plans.

10) Discussion:
Discussion refers to the sharing and analysis of information or findings. In medical contexts, discussions facilitate knowledge exchange among professionals about patient cases, treatment outcomes, and research, allowing for greater understanding of diseases like tuberculosis and their diverse presentations and implications in oral health.

11) Developing:
Developing references regions or countries with emerging economies facing substantial public health challenges, like tuberculosis. Understanding the implications of tuberculosis in developing contexts is essential for implementing effective health strategies, focusing on prevention and treatment options that are accessible and culturally appropriate to mitigate disease burden.

12) Thomas:
Thomas refers to Dr. Thomas Xavier Paulsingh, mentioned in the context of the case report. His contributions underscore the importance of interdisciplinary collaboration in medical management, emphasizing that even specific cases benefit from the collective expertise of professionals to ensure comprehensive patient care and effective treatment plans.

13) Reason:
Reason denotes a rationale or cause for an occurrence. In a medical context, identifying the underlying reason behind symptoms, such as gingival swelling in tuberculosis cases, informs diagnosis and treatment strategies. Understanding these causative factors is essential for effective patient management and education.

14) Ulcer:
Ulcer refers to a sore or lesion on a body surface, indicative of underlying pathology. In the context of oral health, ulcers can represent complications arising from diseases like tuberculosis. Recognizing different ulcer types and their implications is crucial for accurate diagnosis and appropriate therapeutic response.

15) Tear:
Tear indicates a break in tissue integrity, often resulting from injury or infection. In relation to tuberculosis, mucosal tears may facilitate self-inoculation of pathogens. Understanding the mechanisms of injury and infection pathways informs clinicians how to prevent disease spread and manage oral health conditions effectively.

Other Science Concepts:

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Discover the significance of concepts within the article: �Tuberculous gingival enlargement: A rare clinical manifestation�. Further sources in the context of Science might help you critically compare this page with similair documents:

Erythrocyte sedimentation rate, Oral cavity, Histopathological examination, Chronic inflammatory disease, Poor oral hygiene, Antitubercular treatment, Asymptomatic swelling, Gingival enlargement, Tuberculous lymphadenitis, Primary tuberculosis, Tuberculous granuloma.

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