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Year : 2009  |  Volume : 52  |  Issue : 3  |  Page : 442-443
Gingival tuberculosis

1 Department of Pathology, Government Dental College, Patiala, India
2 Department of Periodontia, Government Dental College, Patiala, India

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Date of Web Publication12-Aug-2009

How to cite this article:
Bal MS, Bharti V, Singh A. Gingival tuberculosis. Indian J Pathol Microbiol 2009;52:442-3

How to cite this URL:
Bal MS, Bharti V, Singh A. Gingival tuberculosis. Indian J Pathol Microbiol [serial online] 2009 [cited 2021 Jun 22];52:442-3. Available from: https://www.ijpmonline.org/text.asp?2009/52/3/442/55023


Oral tuberculosis, especially of gingiva, is uncommon. Only a few cases have been reported in the world literature.

A 40-year-old female presented with enlargement of gingiva in left upper anterior region. It was reddish, ulcerative and bleeding [Figure 1]. Earlier the patient was treated for inflammatory disorders but to no avail. An incisional biopsy from the swollen reddish part grossly was in the form of multiple grayish white and pinkish soft tissue pieces, collectively measuring 0.8 x 1 cm.

Microscopic examination showed epithelioid cell granulomas with caseous necrosis surrounded by lymphocytes, epithelioid cells and Langhans type of giant cells [Figure 2]. The diagnosis of necrotizing epithelioid granulomatous lesion with possibilities of tuberculosis and fungal infections was given. Mantoux test was positive (10.2mm induration in 24 h). ZN staining of the tissue sections and sputum examination were negative for AFB. X-ray chest was normal. The underlying bone was not involved.

Total and differential lukocyte counts (TLC and DLC) were within normal limits. The erythrocyte sedimentation rate (ESR) was elevated (48 mm in first hour WG). With the background of these findings, ELISA for detecting IgM, IgG, anti-mycobacterium tuberculosis antibodies was positive suggesting tuberculosis infection.

Later, it was confirmed by polymerase chain reaction (PCR) on scrapings. Patient was put on anti-tubercular therapy and she has responded well.

Tuberculosis of the oral cavity is uncommon which must be considered in the differential diagnosis of granulomatous lesions in the Indian subcontinent. The possibility of primary lesions elsewhere in the body should be ruled out before arriving at the diagnosis of primary tuberculosis.

The diagnosis was supported by other relevant investigations and the patient has improved with anti-tubercular therapy.

Gingival enlargements which are not responding to usual anti-inflammatory treatment must be biopsied and if granulomas are seen, possibility of granulomatous lesions including primary oral tuberculosis must be considered, as incidence of tuberculosis is increasing day by day in India.

Tuberculosis of the oral cavity is very rare. At this site, it is usually seen on the tongue as a painful ulcer. [1] It may also occur on the floor of the mouth, lip, cheek, soft palate, anterior tonsillar pillar, uvula, gingiva and alveolar mucosa. [2],[3]

Oral tuberculous lesions are usually secondary to lung involvement [4] and are frequently seen affecting up to 0.5% of elderly tuberculosis patients, however, primary oral tuberculosis affecting gingiva is very rare. [5]

   References Top

1.Rosai J. Oral Cavity and Oropharynx. Ackerman's Surgical Pathology. Vol 1. 8 th ed. Singapore: Harcourt Brace and Company Asia PTE Ltd; 1996. p. 226.  Back to cited text no. 1    
2.Rauch DM, Friedman E. Systemic tuberculosis initially seen as an oral ulceration: report of a case. J Oral Surg 1978;36:387-9.  Back to cited text no. 2    
3.Hashimoto Y, Tanioka H. Primary tuberculosis of tongue: r0 eport of a case. J Oral Maxillofac Surg 1989;47:744-6.  Back to cited text no. 3    
4.de Aguiar MC, Arrais MJ, Mato MJ. Tuberculosis of the oral cavity: a0 case report. Quintessence Int 1997;28:745-7.  Back to cited text no. 4    
5.Sharma CG, Pradeep AR, Karthikeyan BV. Primary Tuberculosis clinically presenting as gingival enlargement: A case report. J Contemp Dent Pract 2006;5:108-14.  Back to cited text no. 5    

Correspondence Address:
Manjit Singh Bal
Department of Pathology, Government Dental College, Patiala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.55023

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  [Figure 1], [Figure 2]


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