Fogorvosi szemle, 2007 (100. évfolyam, 1-6. szám)
2007-10-01 / 5. szám
239 FOGORVOSI SZEMLE ■ 100. évf. 5. sz. 2007. at night spontaneous bleeding occurred. Eating became impossible, and the patient could not close her mouth. Oral surgery was therefore performed (Fig. 4), followed by another 3 surgical interventions up to the end of pregnancy. By the 3rd day following the delivery, the bleeding from the gingiva had stopped completely. After 3 months, the swelling of the gums had also receded and the teeth stabilized. Second pregnancy As a result of the symptoms experienced during the first pregnancy, dental examinations and treatment were performed regularly. In this pregnancy, the dental problems occurred later and remained under control. However, during the 8th month of pregnancy, the condition of the patient suddenly deteriorated severely, nearly from one day to the next. The bleeding was more frequent and heavier than during the first pregnancy, and the epulis on the gingiva was much larger (Figs. 5, 6, 7). Two oral surgical interventions were performed before childbirth. Caesarean section was performed on this occasion too. Following childbirth, the condition did not improve. Four months later, two more interventions were performed. One month after the first surgical intervention, the mobile teeth stabilized, but a large space remained between the right lower second incisor and canine. Fig. 5. 8th month of second pregnancy, with a large pregnancy tumor on the lower left side, and a space between the right lower lateral incisor and canine The epulis removed (Fig. 7) was subjected to histopathological examination. “Hematoxylin and Eosin staining was performed. CD 34 immunoperoxidase reaction was carried out to show endothelial cells. The surface of the sample included a multilayered epidermis that was ulcerated in part. The deeper layers contained several vascular lumina embedded in scarred environments with an oval or zig-zag shape. The endothelial cells lining the lumina were swollen in places. Not far from the lumina, close to the surface, there were infiltrations containing lymphocytes and plasma cells, as well as neutrophilic granulocytes." The results of histological and immunohistochemical examinations are to be seen in Figs. 8, 9, 10. Discussion and conclusions A number of publications have dealt with pregnancy gingivitis, the dental and parodontological condition of pregnant women and the role of oral hygiene in the development of gingivitis [1,2,13,21]. Through the use of animal experiments, several authors have pointed out that sex hormones play a considerable role in the development of gingivitis and pregnancy epulis [2, 15]. The view is currently held that the combined effects of local (plaque) and overall (hormonal) factors lead to the development of pregnancy gingivitis and epulis [3, 7, 19, 22, 25], Sex hormones seem to act as growth factors for the subgingival bacterial flora, and in particular for Gram-negative anaerobic rods [7]. Yuan and Lin [26] additionally ascribe roles to the vascular endothelial growth factor and angiopoietin-2 in the development of pregnancy granuloma. All these data suggest that the only way to prevent pregnancy Fig. 6. Oral picture after surgical removal of pregnancy epulis epulis is to eliminate the local causes (e.g. dental plaque and the irritation factors). At the same time, the heavy bleeding, the inability to eat, and the aesthetic disadvantges resulting from the epulis often require its removal [10, 11]. The case report of Wang et al. [24] described the epulis of a 28-year-old pregnant woman that stopped bleeding continuously only 5 days af-
