Gingival hyperplasia being the first sign of Wegener's granulomatosis

Wegener's granulomatosis (GW) is a multisystemic granulomatous vasculitis that predominantly affects the airways and the kidneys, but may affect any organ. Otorhinolaryngological manifestations may be gingival swelling, oral ulcer or septal perforations that can cause saddle nose deformities, rhinitis, sinusitis and hearing loss. We report a case of WG that was first diagnosed on oral gingival mucosa. A 54-year old woman was referred to a specialized dentist because of consistent irritative buccal gingival hyperplasia that did not react to conservative and microbial treatment. The lesion was biopsied and the diagnosis was suggestive for WG. Patient was further referred to the Unit of Rheumatology and the diagnose of WG was confirmed and treated. This case emphasizes the importance to recognize the oral manifestation of WG to get proper medication as soon as possible and avoid serious systemic tissue damage.