Plasma cell gingivitis associated with nickel allergy: diagnostic challenges and patient management - a case report

This report aims to present the clinical features, treatment approach, and management guidelines for plasma cell gingivitis (PCG) associated with nickel allergy. A 63-year-old woman was admitted to the clinic with complaints of gingival overgrowth and bleeding. Anamnesis and clinical examination revealed that she had been wearing metal-based fixed prostheses for 15 years. A complete blood count was performed and, after excluding malignancy, histopathologic evaluation revealed a diagnosis of PCG. A skin patch test confirmed nickel allergy, supporting the suspected link between the gingival condition and prolonged exposure to nickel-containing dental prostheses. Nickel levels in gingival tissues were evaluated using atomic absorption spectroscopy (AAS) before and after removal of restorations. AAS measurements detected 6.6 μg/g of nickel before removal and no more than blank analysis afterward. Following phase one and surgical periodontal treatment, and systemic steroid therapy, zirconium-supported prostheses were fabricated. The patient's gingival tissues returned to a healthy condition. This case report shows that PCG related to nickel allergy is characterised by gingival overgrowth with a fiery-red appearance. To confirm clinical findings, histopathological evaluation should include nickel quantification whenever possible. Treatment options should prioritise the elimination of nickel-containing prostheses, with substitution by all-ceramic restorations, to achieve resolution and prevent recurrence.