Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 10  |  Issue : 4  |  Page : 1088-1092

Analysis of gingival biopsies in the Gujarati population: A retrospective study


Department of Oral and Maxillofacial Pathology, KM Shah Dental College and Hospital, Pipariya, Vadodara, Gujarat, India

Date of Web Publication9-Jan-2015

Correspondence Address:
Bhari Sharanesha Manjunatha
K M Shah Dental College and Hospital, Sumandeep Vidyapeeth, Pipariya 391 760, Vadodara, Gujarat
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.137929

Rights and Permissions
 > Abstract 

Background: Biopsy is an important diagnostic tool used in the diagnosis of lesions ranging from simple non-neoplastic, tumor-like lesions to malignancies, and is often the only way to diagnose oral lesions and diseases. The gingiva is the most common site for some kind of irritation or low-grade injury, resulting in localized overgrowths that are considered to be reactive and non-neoplastic lesions. This aim of this study is to analyze the frequency and distribution of gingival lesions in the Gujarati population.
Materials and Methods: In this retrospective study, gingival biopsies submitted for a period of five years were included. Microscopic slides of all the cases were reviewed by two observers for confirmation of the diagnosis.
Results: Among the 106 cases of gingival biopsies, the most frequent category of lesions encountered was the non-neoplastic category, which accounted for 73.58% of the cases. Both benign and malignant neoplasms constituted 26.42% of the cases. Among the non-neoplastic lesions, Pyogenic granuloma was the most frequent lesion (38.46%), followed by fibrous hyperplasia (20.51%), inflammatory hyperplasia (19.23%), and Epulis (8.97%). Neoplasms accounted for 26.42% of the gingival biopsies (92.85% benign and 7.15% malignant). Among the benign neoplastic lesions, Fibroma (30.76%) and Fibrolipoma (26.92%) were the most frequent, followed by peripheral ossifying fibroma (23.08%) and peripheral giant cell granuloma (11%).
Conclusion: It is difficult to compare studies carried out in various countries due to differences in people's attitudes toward oral health and the accessibility of various population groups to biopsy services. Nevertheless, this study has provided some information about the frequency and distribution of biopsied gingival lesions in the Gujarati population over a period of five years.

 > Abstract in Chinese 

古吉拉特人牙龈活检分析:一项回顾性研究

摘要

背景:活检是一种重要的诊断工具,用于诊断简单的非肿瘤性病变、肿瘤样病变以及恶性肿瘤,在诊断口腔病变和疾病方面也常是唯一的方法。牙龈是某种刺激或低等级的伤害最常见的部位,导致局部增生,被认为是反应性和非肿瘤性病变。本研究的目的是分析在古吉拉特人牙龈病变的频率和分布。

材料与方法:本回顾性研究中,包括了五年内提交的的牙龈组织活检。所有病例切片由两位观察员回顾以确认诊断。



结果:106例牙龈活检中,遇到的最常见的类型是非肿瘤性病变,占73.58%。良性和恶性肿瘤占26.42%。非肿瘤性病变中,化脓性肉芽肿是最常见的病变(38.46%),其次是纤维增生(20.51%),炎性增生(19.23%)和牙龈瘤(8.97%)。肿瘤占牙龈活检的26.42%(92.85%良性,7.15%恶性)。良性肿瘤性病变中,纤维瘤(30.76%)和纤维脂肪瘤(26.92%)是最常见的,其次是外周骨化性纤维瘤(23.08%)和周围性巨细胞肉芽肿(11%)。

结论:由于人们对口腔健康态度和各种人群来活检服务的可及性的差异,很难在不同国家进行比较研究。然而,这项研究提供了五年来在古吉拉特的人口的关于牙龈病变活检的频率和分布的信息。

关键词:良性和恶性肿瘤,巨细胞肉芽肿,牙龈活检,组织病理学,化脓性肉芽肿性病变


Keywords: Benign and malignant tumors, giant-cell granuloma, gingival biopsy, histopathology, pyogenic granuloma, reactive lesions


How to cite this article:
Manjunatha BS, Sutariya R, Nagamahita V, Dholia B, Shah V. Analysis of gingival biopsies in the Gujarati population: A retrospective study. J Can Res Ther 2014;10:1088-92

How to cite this URL:
Manjunatha BS, Sutariya R, Nagamahita V, Dholia B, Shah V. Analysis of gingival biopsies in the Gujarati population: A retrospective study. J Can Res Ther [serial online] 2014 [cited 2019 Nov 13];10:1088-92. Available from: http://www.cancerjournal.net/text.asp?2014/10/4/1088/137929


 > Introduction Top


The gingiva is a common site for many neoplastic or non-neoplastic lesions. [1] Non-neoplastic lesions are usually inflammatory or represent a reaction to some kind of irritation or low-grade injury. [2] A great majority of localized overgrowths of the gingiva are considered to be reactive and non-neoplastic lesions. [3] A biopsy is often the only way to diagnose such oral lesions and diseases.

Oral tissue biopsy may be necessary for lesions that cannot be diagnosed on the basis of clinical and radiographic findings alone.When additional information is required to guide any indicated therapy, biopsy to provide tissue for microscopic analysis is often the definitive procedure. [2]

Very few studies with reference to gingival lesions have been reported from different countries. [3] Pyogenic granuloma, peripheral ossifying fibroma or plaque-induced periodontal diseases, such as gingivitis and various types of periodontitis, constitute the vast majority of periodontal conditions that a dental clinician is likely to see in the gingiva, which is frequently the site of other pathological conditions. These conditions can be classified as either neoplastic or non-neoplastic. Non-neoplastic lesions are usually inflammatory or represent a reaction to some kind of irritation or low-grade injury. Neoplasms, on the other hand, represent a process characterized by progressive autonomous growth that can either have a benign or a malignant course. Clinical differential diagnosis of gingival lesions is often dependent on obvious changes in color, size, consistency, and relationship to the neighboring structures. Knowledge of the frequency and distribution of such lesions is also essential for establishing a diagnosis and for planning treatment. [3]

The epidemiology of gingival lesions (neoplastic and inflammatory) in the Gujarati population is not documented in literature to date. The aim of this study was to analyze the frequency and distribution of gingival lesions in the Gujarati population.


 > Materials and method Top


A retrospective study was done on gingival biopsies obtained over a period of five years from 1 January 2006 to 31 December 2010, in the Department of Oral Pathology. We reviewed the medical records of all the patients who had undergone biopsies during this period. Data regarding the age and gender of the subjects and the location and type of lesions were obtained from the biopsy register for each case. Histopathological examination was the method of diagnosis in all cases. The lesions occurring on the gingiva were classified into two categories (1) Neoplastic and (2) non neoplastic.

The following criteria were used:

Inclusion criteria


  1. All age groups and both genders
  2. Reports with adequate case histories
  3. Gingival biopsies (Excisional and incisional).


Exclusion criteria

  1. Subjects taking anticonvulsant drugs, calcium-channel blockers, and immunosuppressants
  2. Edentulous subjects.


Statistical analysis was executed using the Microsoft Excel computer software


 > Results Top


Among a total of 106 cases of gingival biopsies, the most frequent category of lesions encountered was the non-neoplastic lesions, which accounted for 73.58% of the cases [Figure 1]. Neoplasms, on the other hand, accounted for 26.42% of the cases [Figure 1]. There were 68 female patients and 38 male patients, with a female to male ratio of 1.8:1.
Figure 1: Pie diagram showing the frequency of all biopsied gingival lesions

Click here to view


The demographic details of the type, distribution, and location of all non-neoplastic lesions are shown in [Table 1]. Most non-neoplastic lesions were common in females, about 69% [Figure 2]a and b, and in the maxilla. The pyogenic granuloma was the most frequent non-neoplastic lesion (38.42%) followed by fibrous hyperplasia and inflammatory hyperplasia [Figure 3]. Epulis was more common in males than in females [Figure 4]a. Surprisingly, the distribution of individual non-neoplastic lesions among the upper and lower arches was variable [Figure 4]b. Of the 78 non-neoplastic lesions, a peak incidence of occurrence was apparent between the ages of 10 and 19 years, followed by 20 and 29 years, and 60 and 69 years.
Figure 2: (a) Bar chart showing gender and number of gingival biopsies, (b) Bar chart showing distribution of gingival biopsies in both jaws

Click here to view
Figure 3: Pie diagram showing the frequency and types of non-neoplastic gingival lesions

Click here to view
Figure 4: (a) Bar chart showing gender distribution of non-neoplastic gingival lesions, (b) Bar chart showing types and jaw distribution of non-neoplastic gingival lesions

Click here to view
Table 1: Frequency, site, and gender distribution of biopsied non-neoplastic gingival lesions


Click here to view


Neoplasms accounted for 26.42% of the total 106 gingival biopsies (92.85% benign and 7.15% malignant), as listed in [Figure 1]. Benign neoplasms were categorized into six types, as shown in [Table 2]. Out of the 26 the benign neoplasms, eight cases (30.76%) of fibroma and seven cases (26.92%) of fibrolipoma were the most frequent, followed by six cases (23.08%) of peripheral ossifying fibroma [Figure 5]. Benign neoplasms were higher in the mandibular arch than in the maxilla [Table 2]. The most common lesion was a fibroma and the peak was in the 20 to 29 year age group. Of the 26 benign neoplasms, 18 cases (69%) were found in females and eight cases (31%) were found in males, shown in [Table 2] and [Figure 6]a. In contrast to non-neoplastic lesions, all benign neoplasms, except for fibroma, showed predilection for the lower jaw [Figure 6]b. Among malignant neoplasms, only two cases of Oral Squamous Cell Carcinoma (OSCC) were noted on the gingiva. Both cases were present in females and distributed equally in both jaws. The frequency, site, and gender distribution of malignant neoplasms was shown in [Table 2].
Figure 5: Pie diagram showing the frequency and types of benign neoplastic gingival lesions

Click here to view
Figure 6: (a) Bar chart showing gender distribution of benign neoplastic gingival lesions, (b) Bar chart showing types and jaw distribution of benign neoplastic gingival lesions

Click here to view
Table 2: Frequency, site, and gender distribution of biopsied neoplastic gingival lesions


Click here to view



 > Discussion Top


To the best of our knowledge, the present study is the first reported on the frequency and distribution of biopsied gingival lesions in the Gujarati population. A majority of the gingival biopsies showed non-neoplastic lesions, a finding in agreement with the studies of Ababneh, [4] Macleod et al,[5] and Zarei et al. [6] In our study, the most commonly biopsied non-neoplastic lesion was the pyogenic granuloma [Figure 7]a and b and this was in accordance with other studies. [1],[4] In this study, a peak incidence of occurrence of all non-neoplastic lesions was noticed in patients between the ages of 10 and 19 years, while in the studies of Ababneh [4] and Bataineh et al,[7] it was found between the ages of 20 and 29 years. In the present study, it was found that females were more frequently affected with pyogenic granuloma and this was overall in agreement with other studies. [6],[8] About 56.7% of the cases of pyogenic granuloma were found in the maxillary gingiva, which were slightly lower than those reported by Ababneh [4] (64%) and higher than those reported by Zhang et al,[9] (47.10%). In our study, neoplasms accounted for 26.42%, which was higher than that reported for gingival lesions. [2] In the current study, fibroma (30.76%) was the most frequent benign neoplasm occurring in the maxilla compared to the mandible. In contrast, in the study carried out by Shamim et al, [10] fibroma was more commonly found in the mandible.
Figure 7: (a) Clinical image of a case of pyogenic granuloma in the mandibular anterior gingiva, (b) Photomicrograph showing ulcerated oral epithelium with proliferation of blood vessels and inflammatory cells (H and E, ×100)

Click here to view


Some authors [11],[12] group peripheral ossifying fibromas as non-neoplastic lesions together with pyogenic granulomas and peripheral giant-cell granulomas. In our case series, the peripheral ossifying fibroma is subdivided as a benign neoplasm, as reported earlier. [4],[13] The current study suggests a female predilection of peripheral ossifying fibroma, which is consistent with the results reported by Kfir et al., [11] and Southam and Venkataraman. [14] Peripheral giant cell granuloma is often more common in females than in males. [9] In the present study, male-to-female ratio was 1:1.8. In a study carried out by Motamedi et al., [15] the prevalence of peripheral giant-cell granuloma was the same in both genders [Figure 8]a and b.
Figure 8: (a) Clinical photograph of a case of peripheral giant-cell granuloma in the mandibular anterior area, (b) Photomicrograph showing parakeratinized stratified squamous epithelial lining with areas of giant cells and granulation tissue (H and E, ×200)

Click here to view


A case of generalized recurrent gingival enlargement was seen in an 18 year old female patient which turned out be tuberculous gingivitis microscopically [Figure 9]a and b.
Figure 9: (a) Clinical image of a case of generalized recurrent gingival enlargemen (b) Photomicrograph showing granuloma formation with Langhan's giant cells, typical of tuberculosis in the connective tissue (H and E, ×450)

Click here to view


Three cases of fibrolipoma and one case of giant cell fibroma have been reported earlier, as individual case reports, by various authors of this study. [16],[17]


 > Conclusion Top


This study indicates that gingival biopsies of Gujarati patients are similar to those reported in the Literature, although there are some differences due to demographic variations. It is difficult to compare studies carried out in different countries because of differences in people's attitude towards oral health and the accessibility of the various population groups to biopsy services. Similar studies have to be instituted in other centers of India to draw an inference regarding the epidemiology of gingival lesions. Moreover, the data presented in this study can be used as a guide for additional multicenter studies in India.

 
 > References Top

1.
Lindhe J, Karring T, Lang NP. Clinical Periodontology and implant dentistry. 4 th ed. Copenhagen: Blackwell Munksgaard; 2003. p. 298.  Back to cited text no. 1
    
2.
Oliver RJ, Sloan P, Pemberton MN. Oral biopsies: Methods and applications. Br Dent J 2004;196:329-33.  Back to cited text no. 2
    
3.
Layfield LL, Shopper TP, Weir JC. A diagnostic survey of biopsied gingival lesions. J Dent Hyg 1995;69:175-9.  Back to cited text no. 3
    
4.
Ababneh K. Biopsied Gingival Lesions in Northern Jordanians: A Retrospective Analysis over 10 Years. Int J Periodontics Restorative Dent 2006;26:387-93.  Back to cited text no. 4
    
5.
Macleod RI, Soames JV. Epulides: A clinicopathological study of a series of 200 consecutive lesions. Br Dent J 1987;163:51-3.  Back to cited text no. 5
    
6.
Zarei MR, Chamani G, Amanpoor S. Reactive hyperplasia of the oral cavity in Kerman province, Iran: A review of 172 cases. Br J Oral Maxillofac Surg 2007;45:288-92.  Back to cited text no. 6
    
7.
Bataineh A, Al-Dwairi ZN. A survey of localized lesions of oral tissues: A clinicopathological study. J Contemp Dent Pract 2005;6:30-9.  Back to cited text no. 7
    
8.
Ramos O, CortezAY, Vazquez PF, Herrara JC, Carrilo N. Pyogenic granuloma. Med Oral Patol Oral Cir Buccal 2006;11:E351.  Back to cited text no. 8
    
9.
Zhang W, Chen Y, An Z, Geng N, Bao D. Reactive gingival lesions: A retrospective study of 2,439 cases. Quint Int 2007;38:103-10.  Back to cited text no. 9
    
10.
Shamim T, Varghese VI, Shameena PM, Sudha S. A retrospective analysis of gingival biopsied lesions in south Indian population: 2001-2006. Med Oral Patol Oral Cir Bucal 2008;13:E414-8.  Back to cited text no. 10
    
11.
Kfir Y, Buchner A, Hansen LS. Reactive lesions of the gingiva. A clinicopathological study of 741 cases. J Periodontol 1980;51:655-61.  Back to cited text no. 11
    
12.
Buchner A, Hansen LS. The histomorphologic spectrum of peripheral ossifying fibroma. Oral Surg Oral Med Oral Pathol 1987;63:452-61.  Back to cited text no. 12
    
13.
Stablein MJ, Silverglade LB. Comparative analysis of biopsy specimens from gingiva and alveolar mucosa. J Periodontol 1985;56:671-6.  Back to cited text no. 13
    
14.
Southam JC, Venkataraman BK. Calcification and ossification in epulides in man (excluding giant cell epulides). Arch Oral Biol 1973;18:1243-53.  Back to cited text no. 14
    
15.
Motamedi MH, Eshghyar N, Jafari SM, Lassemi E, Navi F, Abbas FM, et al. Peripheral and central giant cell granaloma of the jaws: A demographic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:39-43.  Back to cited text no. 15
    
16.
Manjunatha BS, Pateel GS, Shah V. Oral fibrolipoma-a rare histological entity: Report of 3 cases and review of literature. J Dent (Tehran) 2010;7:226-31.  Back to cited text no. 16
    
17.
Shah M, Rathod CV, Shah V. Peripheral giant cell fibroma: A rare type of gingival overgrowth. J Indian Soc Periodontol 2012;16:275-7.  Back to cited text no. 17
[PUBMED]  Medknow Journal  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  >Abstract>Introduction>Materials and method>Results>Discussion>Conclusion>Article Figures>Article Tables
  In this article
>References

 Article Access Statistics
    Viewed1994    
    Printed64    
    Emailed0    
    PDF Downloaded208    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]