Juvenile Spongiotic Gingivitis

Background: This article recognizes the microscopic diagnosis of acute spongiotic mucositis as an analog to acute spongiotic dermatitis of the skin and defines a specific clinicopathological entity “juvenile spongiotic gingivitis” within this microscopic spectrum. Methods: Twenty‐four patients, usually juveniles, with patches of bright red, often slightly thickened, painless, and persistent lesions of the attached gingiva, which may or may not involve the marginal gingiva, were identified by clinical and microscopic features. Immunohistochemical studies for cytokeratins 5/6 and 19, estrogen receptors, and progesterone receptors were completed on 10 of these cases. A comparison to puberty gingivitis, which occurs in the same age group, was done. Results: Microscopically, the epithelium exhibited hyperplasia, significant spongiosis, loss of keratinization, and a neutrophilic infiltrate, sometimes with microabscess formation, whereas the underlying connective tissue exhibited an acute on chronic inflammatory infiltrate. Full‐thickness epithelial immunostaining for cytokeratins 5/6 and 19 was found, whereas no reactivity was seen for estrogen receptors or progesterone receptors in the specimens. Conclusions: Juvenile spongiotic gingivitis differs from puberty gingivitis by not needing to show continuity with plaque‐related marginal gingivitis, by a lack of response to hygiene procedures, by an occasional occurrence at ages not related to puberty, and by the absence of sex hormone receptors investigated immunohistochemically in 10 of the cases. We propose juvenile spongiotic gingivitis as a distinct clinicopathological entity.