Plasma cell gingivitis: A systematic review and guideline to diagnosis

Plasma cell gingivitis is a rare non-dental plaque-induced gingival disease often associated with hypersensitivity reactions. Due to its rarity many questions present around its presentation, etiology, and treatment. Moreover, its histopathology has many similarities with other periodontal condition such as periodontitis. The present systematic review aimed to assess the cases of plasma cell gingivitis focusing on its clinical features, possible etiologic factors, and treatment modalities.

The search was done in The MEDLINE database, Scopus, and Web of Science from January 1999 until August 2024 for English publications using the following terms: (plasma cell gingivitis OR atypical gingivostomatitis OR allergic gingivostomatitis) AND (etiology OR clinical feature OR clinical manifestation OR treatment OR management). Any presented cases with clinical manifestation of plasma cell gingivitis confirmed with histopathologic assessment were included. Studies with unclear data, periodontitis or gingivitis cases which was not first treated for periodontal disease or not allowed for proper check-ups were excluded.

Sixteen articles comprise 19 cases included in this review from them 13 were female (68.420 %) and 6 were male (31.57 %) with wide age range from 9 to 64 years. Anterior of the maxilla were affected in all cases. Erythematous gingiva are presented in all cases which were mostly diffuse involvement. Bleeding on slight provocation and lip swelling were another clinical signs. Treatment modalities were different from discontinuing possible etiologic factors, topical drugs, to removing the lesion, and photobiomodulation.

In cases of gingival inflammation, it is important to first rule out other diseases such as gingivitis, periodontitis, and inflammatory gingival enlargement. The diagnosis of plasma cell gingivitis should be based on a detailed past medical history, accurate clinical evaluation, laboratory, microscopic, and immunohistochemical assessment.