The Case of "Suspected" Plasma Cell Gingivitis

A resident in the general practice told me that she had a patient in her chair whose gingiva looked identical to the picture of plasma cell gingivitis in Dr. Allen's book*. The patient was 23-year-old intellectually disable woman. Her parents told us that her gums are usually this red. They schedule cleanings under sedation every six months because she refuses to brush. They couldn't recall if it gets better after the cleaning appointment.

23-year-old diabetic female with plaque deposition and gingivitis

(I apologize for the quality of the picture, the girl was wonderful during the exam but would not let us use retractors)

The patient had a complex medical history with all sorts of problems including heart disease and diabetes.

Based on the medical history and the clinical picture, this condition was diagnosed as diabetic gingivitis. (Plasma cell gingivitis is an entirely different process, and hopefully will be discussed in the future).


Diabetic gingivitis is not a unique entity, it is just a more severe presentation of "regular" gingivitis seen in diabetic people. It is believed that insufficient glucose control leads to increased bacterial growth and decreased resistance to infection. Patients with diabetes need to be more vigilant about their hygiene routines. Brushing twice a day, flossing daily and professional cleanings every six months are mandatory for this purpose. 


Unfortunately, this young woman was not capable of maintaining such a thorough cleaning regimen but she had minimal dental caries and her periodontal health was not significantly bad. The every 6 month cleaning regimen appeared to be working well for her. This is why it was extremely difficult for me to understand why her regular dentist had recommended complete extractions for this 23-year-old. I asked the parents if she was in pain, they said no. I asked them if she had trouble eating, they said no. "Then why?" was my final question. Their answer was because she didn't brush. 


I spent the next half an hour with her mother and father explaining to them why, in my opinion, full extractions on someone who already has a very difficult life is not a good idea. I don't know if I had managed to convince them and honestly, I am too afraid to ask.

* Oral and Maxillofacial Pathology - Neville, Damm, Allen and Bouqout