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JAMA Clinical Challenge | Clinician's Corner

A Young Patient With Persistent Gingival Bleeding

Juan F. Yepes, DDS, MD, MPH, MS, DrPH; Dean White, DDS, MSD
JAMA. 2012;307(22):2430-2431. doi:10.1001/jama.2012.4307.
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A 13-year-old girl comes to your office for evaluation of ulcers, erythema, and a “peeling off” sensation in her gums. Her gums have been sore and red for at least 6 years. Initially she was diagnosed as having generalized gingivitis despite a low level of local irritants such as dental plaque or calculus. Her medical history is not significant and she is not taking any medication except cetirizine for seasonal allergies. Findings from a general physical examination are within normal limits. Her intraoral examination reveals ill-defined ulcers with marked erythema in the gums (Figure 1). The epithelium “peels” easily, leaving a thin membrane around the teeth. There is no evidence of significant dental plaque accumulation or the presence of local irritants such as calculus. Pertinent laboratory values (complete blood cell count, platelet count, liver panel) are within normal limits.

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Figure 1. Gingival erythema and ulcerations in a 13-year-old patient.

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Figure 2. Gingival punch biopsy showing the characteristic intraepithelial separation (arrowhead), which occurs just above the basal layer of the epithelium (hematoxylin-eosin, original magnification ×40).



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