Localized Juvenile Spongiotic Gingival Hyperplasia

Localized Juvenile Spongiotic Gingival Hyperplasia (Localized Juvenile Spongiotic Gingivitis,
Juvenile Spongiotic Gingivitis)

Initially described in 2007, localized juvenile spongiotic gingival hyperplasia represents a type of inflammatory gingival hyperplasia with distinctive clinicopathologic features. The etiology is unknown, although some investigators have suggested that the condition results from exteriorization of the junctional or sulcular epithelium, with secondary changes caused by local irritating factors (such as mouth breathing). Notably, the alteration does not appear to be plaque-related and does not respond to improved oral hygiene.
Clinically, the condition typically appears as a bright red, slightly raised lesion on the facial gingiva of a young patient. The majority of reported cases have occurred in children and adolescents (average age: 12 years, range: 5 to 39 years), with a female-to-male ratio of 1.3 : 1. There is a strong predilection for the anterior maxillary gingiva. The alteration generally involves the attached gingiva and free gingival margin overlying a tooth root, although some examples primarily involve the interdental papilla. Most patients exhibit a solitary, localized lesion measuring 2 to 10 mm in diameter; however, multifocal or more diffuse involvement also is possible. The surface may appear velvety, granular, pebbly, or papillary. The lesion is usually painless but may bleed easily upon manipulation. In one study, 15% of affected patients had orthodontic brackets, although this finding could be coincidental.
Most reported cases have been treated by conservative excision, with a recurrence rate of 6% to 25%. Isolated examples have been managed by laser treatment or cryotherapy. The paucity of cases occurring in adults suggests that spontaneous resolution is likely, albeit after an unpredictable time period.

Bright red alteration of the anterior maxillary gingiva in a young patient who was receiving orthodontic treatment. (from Color Atlas of Oral and Maxillofacial Diseases)

a SGH presenting as a localized bright red papillary growth of the facial maxillary gingiva in a 9-year-old female. b Medium-power view of SGH in a 33-year-old male. This lesion of recent onset lacks a papillary architecture, but shows epithelial hyperplasia, spongiosis, an absent keratin layer, neutrophilic exocytosis, and a dense chronic inflammatory infiltrate in the connective tissue (original magnification × 100, Hematoxylin & eosin) (from Non-HPV Papillary Lesions of the Oral Mucosa: Clinical and Histopathologic Features of Reactive and Neoplastic Conditions)