Management of patients with foreign body gingivitis: report of 2 cases with histologic findings.

Foreign body gingivitis is an inflammation of the gingiva, characterized by foci containing particles of foreign material in the connective tissue, which can have either a granulomatous or a lichenoid microscopic appearance. In clinical terms, it differs from other immune-mediated gingival disorders in its limited involvement of tissues other than the gingiva, as well as its relative resistance to treatment by topical corticosteroids. Two cases are presented, with a review of the clinical features, including characteristic desquamation and mottling of the marginal gingiva and symptoms of localized tenderness and pain; gingival recession was observed in both of the reported cases. Histologic examination revealed damaged epithelium and degeneration of the basal layer, as well as a mixed inflammatory cell infiltrate in the connective tissue with refractile or opaque particles of foreign material. Gingival inflammation and the severity of gingival erosions improved dramatically with careful debridement, improved home care and more frequent, diligent periodontal maintenance therapy. Free gingival grafts, together with excision of affected tissues, served to stabilize and reinforce the marginal tissues, as well as eliminating further clinical signs of the disease; excision alone was not as effective. Patients require careful dental and periodontal management as well as appropriate oral home care to avoid further mechanical damage to the gingiva; in addition, the use of dental abrasives and polishing agents should be restricted, particularly if gingival lesions are present. Home care recommendations include avoidance of dentifrices with certain chemical additives and rinses with a high alcohol content.