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JAMA Clinical Challenge
Clinician's Corner
June 13, 2012

A Young Patient With Persistent Gingival Bleeding

Author Affiliations

Author Affiliations: Division of Pediatric Dentistry (Dr Yepes) and Division of Oral Pathology (Dr White), University of Kentucky College of Dentistry, Lexington.

JAMA. 2012;307(22):2430-2431. doi:10.1001/jama.2012.4307

A 13-year-old girl comes to your office for evaluation of ulcers, erythema, and a “peeling off” sensation in her gums. Her gums have been sore and red for at least 6 years. Initially she was diagnosed as having generalized gingivitis despite a low level of local irritants such as dental plaque or calculus. Her medical history is not significant and she is not taking any medication except cetirizine for seasonal allergies. Findings from a general physical examination are within normal limits. Her intraoral examination reveals ill-defined ulcers with marked erythema in the gums (Figure 1). The epithelium “peels” easily, leaving a thin membrane around the teeth. There is no evidence of significant dental plaque accumulation or the presence of local irritants such as calculus. Pertinent laboratory values (complete blood cell count, platelet count, liver panel) are within normal limits.