{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T20:41:02Z","timestamp":1791492062716,"version":"4.3.4"},"reference-count":62,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,10]],"date-time":"2024-12-10T00:00:00Z","timestamp":1733788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: The etiology of diffuse gingival enlargement is multifactorial, and the definitive diagnosis may be challenging. To highlight the nuances of the differential diagnosis, we present two cases of generalized gingival overgrowth and discuss the diagnostic dilemmas. Case description: In the first case, an 82-year-old male with a medical history of hypertension and prostatitis had a chief complaint of symptomatic oral lesions of a 20-day duration, accompanied by fever and loss of appetite. The clinical examination revealed diffusely enlarged, hemorrhagic, and focally ulcerative upper and lower gingiva, ecchymoses on the buccal mucosa, as well as bilateral cervical lymphadenitis. The histopathologic and immunohistochemical findings combined with the hematologic examination led to a final diagnosis of acute myeloid leukemia, and the patient was referred to a specialized hematology\/oncology unit for further management. The second case was a 74-year-old female with a medical history of breast cancer (successfully managed in the past), type II diabetes mellitus, and cardiovascular disease, taking various medications. An intraoral examination revealed diffusely enlarged, erythematous, and hemorrhagic upper and lower gingiva. An incisional biopsy showed hyperplastic granulation and fibrous connective tissue with a predominantly chronic inflammatory infiltrate. Considering the patient\u2019s medical history and current medications, the clinical and microscopic findings were in support of the diagnosis of drug-induced gingival overgrowth associated with calcium channel blocker (amlodipine), partially controlled diabetes serving as an additional predisposing factor. Gingivectomy and periodontal scaling, along with substitution of the offending medication, were curative, and better diabetic control was recommended. Conclusions: Diffuse gingival overgrowth may be caused by a variety of diverse conditions, ranging from an exuberant response to local factors, potentially exacerbated by hormonal influences (e.g., puberty or pregnancy), to drug side effects to genetic, systemic, or even neoplastic diseases. A careful evaluation of the medical and drug history and clinicopathologic correlation is essential for accurate diagnosis and appropriate management.<\/jats:p>","DOI":"10.3390\/dj12120403","type":"journal-article","created":{"date-parts":[[2024,12,10]],"date-time":"2024-12-10T04:15:03Z","timestamp":1733804103000},"page":"403","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Challenges in Differential Diagnosis of Diffuse Gingival Enlargement: Report of Two Representative Cases and Literature Review"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2227-0127","authenticated-orcid":false,"given":"Erofili","family":"Papadopoulou","sequence":"first","affiliation":[{"name":"Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens (NKUA), 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0009-4911","authenticated-orcid":false,"given":"Maria","family":"Kouri","sequence":"additional","affiliation":[{"name":"Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens (NKUA), 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7715-7435","authenticated-orcid":false,"given":"Anastasia","family":"Andreou","sequence":"additional","affiliation":[{"name":"Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens (NKUA), 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Smaragda","family":"Diamanti","sequence":"additional","affiliation":[{"name":"Department of Dentistry, European University Cyprus, Nikosia 22006, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0734-8857","authenticated-orcid":false,"given":"Maria","family":"Georgaki","sequence":"additional","affiliation":[{"name":"Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens (NKUA), 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Katoumas","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens (NKUA), 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8652-4715","authenticated-orcid":false,"given":"Spyridon","family":"Damaskos","sequence":"additional","affiliation":[{"name":"Department of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens (NKUA), 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanouil","family":"Vardas","sequence":"additional","affiliation":[{"name":"Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens (NKUA), 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5389-1837","authenticated-orcid":false,"given":"Evangelia","family":"Piperi","sequence":"additional","affiliation":[{"name":"Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens (NKUA), 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos G.","family":"Nikitakis","sequence":"additional","affiliation":[{"name":"Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens (NKUA), 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.jaad.2004.09.035","article-title":"Diffuse gingival enlargement","volume":"52","author":"Khera","year":"2005","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_2","first-page":"276","article-title":"Drug-Induced Gingival Enlargement: A Review of Diagnosis and Current Treatment Strategies","volume":"43","author":"Barsoum","year":"2022","journal-title":"Compend. Contin. Educ. Dent."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"779","DOI":"10.12998\/wjcc.v3.i9.779","article-title":"Gingival enlargements: Differential diagnosis and review of literature","volume":"16","author":"Agrawal","year":"2015","journal-title":"World J. Clin. Cases"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e249879","DOI":"10.1136\/bcr-2022-249879","article-title":"Gingival enlargement improvement following medication change from amlodipine to benidipine and periodontal therapy","volume":"19","author":"Kamei","year":"2022","journal-title":"BMJ Case Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s00125-011-2342-y","article-title":"Periodontitis and diabetes: A two-way relationship","volume":"55","author":"Preshaw","year":"2012","journal-title":"Diabetologia"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"623427","DOI":"10.1155\/2015\/623427","article-title":"Relationship between gingival inflammation and pregnancy","volume":"2015","author":"Wu","year":"2015","journal-title":"Mediat. Inflamm."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1001\/jama.1939.02800130028009","article-title":"The treatment of epilepsy with sodium diphenyl hydrantoinate","volume":"112","author":"Kimball","year":"1939","journal-title":"J. Am. Med. Assoc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1038\/jhh.2013.47","article-title":"Calcium channel blocker-induced gingival enlargement","volume":"28","author":"Livada","year":"2014","journal-title":"J. Hum. Hypertens."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1177\/0022034515571265","article-title":"Molecular and clinical aspects of drug-induced gingival overgrowth","volume":"94","author":"Trackman","year":"2015","journal-title":"J. Dent. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"499","DOI":"10.4103\/1735-3327.170546","article-title":"Cyclosporine A: Novel concepts in its role in drug-induced gingival overgrowth","volume":"12","author":"Ponnaiyan","year":"2015","journal-title":"Dent. Res. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1111\/odi.12264","article-title":"Mechanism of drug-induced gingival overgrowth revisited: A unifying hypothesis","volume":"21","author":"Brown","year":"2015","journal-title":"Oral Dis."},{"key":"ref_12","first-page":"276","article-title":"Case of hypertrophy of the gums","volume":"9","author":"Goddard","year":"1856","journal-title":"Dent. Regist. West."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e2020140","DOI":"10.4322\/acr.2020.140","article-title":"Generalized hereditary gingival fibromatosis in a child: Clinical, histopathological and therapeutic aspects","volume":"21","author":"Cunha","year":"2020","journal-title":"Autops. Case Rep."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"De Falco, D., Della Vella, F., Scivetti, M., Suriano, C., De Benedittis, M., and Petruzzi, M. (2022). Non-Plaque Induced Diffuse Gingival Overgrowth: An Overview. Appl. Sci., 12.","DOI":"10.3390\/app12083731"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.tripleo.2005.08.014","article-title":"Partial facial hemihyperplasia with 9 years of evolution: Case report and review of the literature","volume":"102","author":"Godoy","year":"2006","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"250","DOI":"10.5005\/jp-journals-10005-1521","article-title":"Nonsyndromic Gingival Fibromatosis: A Rare Case Report","volume":"11","author":"Gandhi","year":"2018","journal-title":"Int. J. Clin. Pediatr. Dent."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1758","DOI":"10.1177\/00220345000790100501","article-title":"Evidence of genetic heterogeneity for hereditary gingival fibromatosis","volume":"79","author":"Hart","year":"2000","journal-title":"J. Dent. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"241","DOI":"10.4103\/ijd.IJD_511_18","article-title":"Oral Manifestations as an Early Clinical Sign of Acute Myeloid Leukemia: A Report of Two Cases","volume":"65","author":"Arora","year":"2020","journal-title":"Indian J. Dermatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"65","DOI":"10.4103\/2229-516X.149251","article-title":"Leukemic gingival enlargement: Report of a rare case with review of literature","volume":"5","author":"Hasan","year":"2015","journal-title":"Int. J. Appl. Basic. Med. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/0030-4220(83)90373-0","article-title":"Malignant gingival and skin \u201cinfiltrates\u201d in adult leukemia","volume":"55","author":"Dreizen","year":"1983","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"293","DOI":"10.5051\/jpis.2014.44.6.293","article-title":"Oral signs of acute leukemia for early detection","volume":"44","author":"Lim","year":"2014","journal-title":"J. Periodontal Implant. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Gu, R., Yang, X., and Wei, H. (2018). Molecular landscape and targeted therapy of acute myeloid leukemia. Biomark. Res., 6.","DOI":"10.1186\/s40364-018-0146-7"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"172641","DOI":"10.1016\/j.ejphar.2019.172641","article-title":"Hematological malignancies and molecular targeting therapy","volume":"862","author":"Shimada","year":"2019","journal-title":"Eur. J. Pharmacol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.sdentj.2019.12.005","article-title":"Granulomatous diseases: Oral manifestations and recommendations","volume":"32","author":"Alhassani","year":"2020","journal-title":"Saudi Dent. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"156","DOI":"10.4103\/jisp.jisp_170_17","article-title":"Tuberculous gingival enlargement: A rare clinical manifestation","volume":"21","author":"Muthuraj","year":"2017","journal-title":"J. Indian Soc. Periodontol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"132","DOI":"10.4103\/jisp.jisp_134_23","article-title":"Gingiva as the primary site of extrapulmonary tuberculosis: A rare case report with brief review of literature","volume":"28","author":"Adhithya","year":"2024","journal-title":"J. Indian Soc. Periodontol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"551","DOI":"10.4103\/0976-237X.123087","article-title":"Gingival enlargement unveiling sarcoidosis: Report of a rare case","volume":"4","author":"Kadiwala","year":"2013","journal-title":"Contemp. Clin. Dent."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"543","DOI":"10.4103\/jomfp.jomfp_143_23","article-title":"Orofacial granulomatosis as a manifestation of sarcoidosis: A rare case report","volume":"27","author":"Galohda","year":"2023","journal-title":"J. Oral Maxillofac. Pathol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Cecchin-Albertoni, C., Pieruccioni, L., Canceill, T., Benetah, R., Chaumont, J., Guissard, C., Monsarrat, P., K\u00e9moun, P., and Marty, M. (2023). Gingival Orofacial Granulomatosis Clinical and 2D\/3D Microscopy Features after Orthodontic Therapy: A Pediatric Case Report. Medicina, 59.","DOI":"10.3390\/medicina59040673"},{"key":"ref_30","first-page":"318","article-title":"Orofacial granulomatosis as early manifestation of Crohn\u2019s disease: Report of a case in a paediatric patient","volume":"17","author":"Sarra","year":"2016","journal-title":"Eur. J. Paediatr. Dent."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/j.mayocp.2017.04.010","article-title":"Crohn Disease: Epidemiology, Diagnosis, and Management","volume":"92","author":"Feuerstein","year":"2017","journal-title":"Mayo Clin. Proc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/S1079-2104(97)90121-9","article-title":"Foreign body gingivitis: Clinical and microscopic features of 61 cases","volume":"83","author":"Gordon","year":"1997","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.oooo.2019.04.009","article-title":"Investigation of foreign materials in gingival lesions: A clinicopathologic, energy-dispersive microanalysis of the lesions and in vitro confirmation of pro-inflammatory effects of the foreign materials","volume":"128","author":"Ferreira","year":"2019","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1902\/jop.2007.060502","article-title":"Juvenile spongiotic gingivitis","volume":"78","author":"Darling","year":"2007","journal-title":"J. Periodontol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.adaj.2018.10.001","article-title":"Reappraising localized juvenile spongiotic gingival hyperplasia","volume":"150","author":"Vargo","year":"2019","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1111\/cup.13549","article-title":"Localized juvenile spongiotic gingival hyperplasia: A report of 27 cases","volume":"46","author":"Wang","year":"2019","journal-title":"J. Cutan. Pathol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.oooo.2020.10.024","article-title":"Localized juvenile spongiotic gingival hyperplasia: Microscopic variations and proposed change to nomenclature","volume":"131","author":"Theofilou","year":"2021","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1111\/his.12774","article-title":"Localized juvenile spongiotic gingival hyperplasia possibly originates from the junctional gingival epithelium-an immunohistochemical study","volume":"68","author":"Allon","year":"2016","journal-title":"Histopathology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.tripleo.2008.04.024","article-title":"Localized juvenile spongiotic gingival hyperplasia","volume":"106","author":"Chang","year":"2008","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"172","DOI":"10.4103\/jomfp.JOMFP_3_19","article-title":"Strawberry gingivitis\u2014First sign of Wegener\u2019s granulomatosis","volume":"24","author":"Dhalkari","year":"2020","journal-title":"J. Oral Maxillofac. Pathol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.tripleo.2005.04.018","article-title":"Wegener\u2019s granulomatosis: The current understanding","volume":"100","author":"Ponniah","year":"2005","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1002\/art.41986","article-title":"2022 American College of Rheumatology\/ European Alliance of Associations for Rheumatology Classification Criteria for Granulomatosis with Polyangiitis","volume":"74","author":"Robson","year":"2022","journal-title":"Athritis Rheumatol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S1079-2104(98)90418-8","article-title":"Wegener\u2019s granulomatosis presenting as oral lesions: A case report","volume":"85","author":"Lilly","year":"1998","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/j.bjoms.2009.02.012","article-title":"Strawberry gingival enlargement as only manifestation of Wegeners granulomatosis","volume":"47","author":"Bhatt","year":"2009","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"90","DOI":"10.2340\/00015555-0008","article-title":"Strawberry gingivitis: An isolated manifestation of Wegener\u2019s granulomatosis?","volume":"86","author":"Nico","year":"2006","journal-title":"Acta Derm. Venereol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Hanisch, M., Fr\u00f6hlich, L.F., and Kleinheinz, J. (2016). Gingival hyperplasia as first sign of recurrence of granulomatosis with polyangiitis (Wegener\u2019s granulomatosis): Case report and review of the literature. BMC Oral Health, 2.","DOI":"10.1186\/s12903-016-0262-4"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"93","DOI":"10.5582\/irdr.2022.01045","article-title":"Granulomatosis with polyangiitis in gingiva: A rare case of isolated presentation","volume":"11","author":"Subramanya","year":"2022","journal-title":"Intractable Rare Dis. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.coms.2022.10.003","article-title":"Plasma Cell Gingivitis and Its Mimics","volume":"35","author":"Younis","year":"2023","journal-title":"Oral Maxillofac. Surg. Clin. N. Am."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"115","DOI":"10.4103\/0972-124X.94618","article-title":"Plasma cell gingivitis associated with cheilitis: A diagnostic dilemma!","volume":"16","author":"Janam","year":"2012","journal-title":"J. Indian Soc. Periodontol."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Leuci, S., Coppola, N., Adamo, N., Bizzoca, M.E., Russo, D., Spagnuolo, G., Lo Muzio, L., and Mignogna, M.D. (2021). Clinico-Pathological Profile and Outcomes of 45 Cases of Plasma Cell Gingivitis. J. Clin. Med., 18.","DOI":"10.3390\/jcm10040830"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"565","DOI":"10.4103\/ccd.ccd_776_18","article-title":"Plasma-Cell Gingivitis a Challenge to the Oral Physician","volume":"10","author":"Negi","year":"2019","journal-title":"Contemp. Clin. Dent."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1038\/s41572-019-0060-9","article-title":"Kaposi sarcoma","volume":"31","author":"Cesarman","year":"2019","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1865","DOI":"10.1126\/science.7997879","article-title":"Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi\u2019s sarcoma","volume":"16","author":"Chang","year":"1994","journal-title":"Science"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e453","DOI":"10.4317\/jced.59610","article-title":"Oral Kaposi Sarcoma in two patients living with HIV despite sustained viral suppression: New clues","volume":"1","author":"Messeca","year":"2022","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"P6","DOI":"10.1186\/1750-9378-7-S1-P6","article-title":"Diagnosing Kaposi\u2019s Sarcoma (KS) in East Africa: How accurate are clinicians and pathologists?","volume":"7","author":"Amerson","year":"2012","journal-title":"Infect. Agents Cancer"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1902\/jop.2006.050226","article-title":"Gingival involvement in a case series of patients with acquired immunodeficiency syndrome-related Kaposi sarcoma","volume":"77","author":"Kalpidis","year":"2006","journal-title":"J. Periodontol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.ejca.2018.12.036","article-title":"Diagnosis and treatment of Kaposi\u2019s sarcoma: European consensus-based interdisciplinary guideline (EDF\/EADO\/EORTC)","volume":"114","author":"Lebbe","year":"2019","journal-title":"Eur. J. Cancer"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1097\/QAI.0000000000003236","article-title":"Predictive Value of Serum Biomarkers for Response of Limited-Stage AIDS-Associated Kaposi Sarcoma to Antiretroviral Therapy With or Without Concomitant Chemotherapy in Resource-Limited Settings","volume":"94","author":"Epeldegui","year":"2023","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1002\/ccr3.114","article-title":"Gingival overgrowth caused by vitamin C deficiency associated with metabolic syndrome and severe periodontal infection: A case report","volume":"2","author":"Omori","year":"2014","journal-title":"Clin. Case Rep."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"E96","DOI":"10.1503\/cmaj.190934","article-title":"Modern-day scurvy","volume":"27","author":"Colacci","year":"2020","journal-title":"Can. Med. Assoc. J."},{"key":"ref_61","first-page":"394","article-title":"Scurvy-scorbutic siderosis of gingiva: A diagnostic challenge\u2014A rare case report","volume":"10","author":"Japatti","year":"2013","journal-title":"Dent. Res. J."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1007\/s11606-008-0577-1","article-title":"Scurvy is still present in developed countries","volume":"23","author":"Velandia","year":"2008","journal-title":"J. Gen. Intern. Med."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/12\/12\/403\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:51:04Z","timestamp":1760115064000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/12\/12\/403"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,10]]},"references-count":62,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["dj12120403"],"URL":"https:\/\/doi.org\/10.3390\/dj12120403","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,10]]}}}