JOURNAL OF IQRO – ЖУРНАЛ ИҚРО – IQRO JURNALI – volume 14, issue 01, 2025
ISSN: 2181-4341, IMPACT FACTOR ( RESEARCH BIB ) – 7,245, SJIF – 5,431
ILMIY METODIK JURNAL
Nurmatov Ortiq Sattarovich
PhD Assistant of the Department of Dentistry, Faculty of Postgraduate Education, Samarkand
State Medical Education University
Zulpanov Qilichbek Nazarali ugʻli
1st year clinical resident Samarkand State Medical Education University
DIFFERENTIAL DIAGNOSIS OF TUMOR-LIKE PERIODONTAL DISEASES
Abstract:
Periodontitis presents a widespread and evolving challenge, making it difficult to
establish clear diagnostic and treatment protocols. The complexity arises from the diverse
etiologies, varying degrees of severity, nature of complications, individual health conditions, and
genetic predispositions associated with periodontal disease.
Comprehensive histological
examination is crucial for accurate diagnosis and the development of effective treatment
strategies for periodontal diseases.
Keywords:
parodontal tissues, еxamination of a parodontal diseases, histological research.
Introduction.
The diagnosis of periodontal diseases currently relies on a set of basic clinical
examinations conducted in an outpatient setting. These assessments encompass evaluation of
gingival health, measurement of periodontal ligament attachment loss, detection of supra- and
subgingival deposits, and radiographic analysis of alveolar bone resorption. While patient history,
clinical examination, and periodontal indices contribute to the diagnostic process, the lack of
standardization among various periodontal indices has led to divergent opinions within the dental
community regarding their utility. Consequently, many practitioners remain hesitant to fully
embrace these indices in routine practice. Furthermore, simply assessing oral hygiene status and
the extent of existing periodontal damage provides limited diagnostic value.
The purpose
The primary goal of periodontal diagnosis is not simply to identify disease
presence but to pinpoint the specific disease responsible for observable changes in periodontal
tissues. A crucial aspect of this process involves distinguishing between diagnostic signs, which
often share similar clinical presentations and symptoms. When focusing solely on inflammatory
and degenerative changes within periodontal tissues, conventional examination methods are
generally adequate for differentiating these conditions. However, when dealing with tumors and
tumor-like diseases affecting the oral cavity and periodontium, traditional diagnostic approaches
prove insufficient.
Furthermore, the constraints of outpatient settings in contemporary dental clinics often preclude
the use of supplementary laboratory investigations, including histological analysis of biopsies
obtained through surgical periodontal treatments.
The purpose of our work
is to clearly demonstrate the need for a more complete and in-depth
examination of a periodontal patient for diagnostic stage, including for identifying tumors and
tumor-like periodontal diseases. This work analyzes the principles differential diagnosis of
inflammatory dystrophic periodontal diseases. As is known, the main differential diagnostic. A
sign for gingivitis, in contrast to other periodontal diseases, should be considered the absence of
changes in the bone tissue of the alveoli, which is an integral part of the periodontal complex.
JOURNAL OF IQRO – ЖУРНАЛ ИҚРО – IQRO JURNALI – volume 14, issue 01, 2025
ISSN: 2181-4341, IMPACT FACTOR ( RESEARCH BIB ) – 7,245, SJIF – 5,431
ILMIY METODIK JURNAL
The severity of gingivitis is determined by the totality of general changes in the div identified
on stage of history taking and the degree of gum involvement in pathological process.
Differential diagnostics of chronic, catarrhal and hypertrophic (edematous form) gingivitis is
associated with a certain commonality of the clinical picture: patients complain of bleeding gums,
changes in the appearance of the gingival margin. Usually, the proliferative process characteristic
of hypertrophic gingivitis is preceded by catarrhal inflammation, therefore, on one jaw, one can
observe the phenomena of catarrhal gingivitis, and on the other - hypertrophic. Distinctive signs
come from the presence in the examined patients of various general somatic diseases that cause
gingivitis: in catarrhal gingivitis, most often cardiovascular, gastrointestinal, infectious diseases,
blood diseases (lymphocytic and myeloleukemia). In hypertrophic gingivitis — endocrine
pathology, intake of certain medications, as well as blood diseases (leukemic reticulosis).
Accordingly, the clinical picture will be different: swelling and hyperemia of the interdental
papillae and gingival margin in catarrhal gingivitis; enlargement of the gingival papillae,
pronounced deformation of the gingival margin, cyanosis, formation of false periodontal pockets
— in hypertrophic gingivitis. Differential diagnostics of ulcerative necrotic gingivitis from
generalized periodontitis in the acute stage is associated with the commonality of some
symptoms: in both cases, the general condition of the patient suffers, signs of intoxication appear,
and pain syndrome is pronounced. With these two pathologies, swelling and hyperemia of the
gingival margin, lost scalloping of the gum, painful palpation, poor oral hygiene (large amounts
of soft plaque and hard dental deposits), halitosis are determined. Sharp bleeding with trauma to
the gingival margin, suppuration upon palpation Ulcerative necrotic gingivitis is characterized by
necrotic plaque on the gums and flattened gingival papillae. Plaque removal is extremely painful
and results in significant bleeding.
Acute periodontitis presents with pus-filled pockets, potential abscesses, smoothing of the gum
line, swelling, pulsation upon touch, and possible fistula formation. X-rays reveal mixed bone
resorption, with vertical resorption and cavity formation in areas of active inflammation. Bone
pocket depth corresponds to the severity of periodontitis. Notably, ulcerative necrotic gingivitis
does not show bone structure changes on X-ray. Differentiating chronic (catarrhal and
hypertrophic) gingivitis from mild chronic generalized periodontitis involves identifying specific
clinical features. Both conditions share symptoms like bleeding gums, swollen and red gums,
soft and hard plaque buildup, and abnormal periodontal indices. The Schiller-Pisarev test is
positive in both cases. However, periodontitis exhibits periodontal pockets up to 4 mm deep and
bone resorption of the interalveolar septum by up to one-third its length. Functional examination
methods like rheoparodontography and polarography are not helpful for differential diagnosis.
Localized hypertrophic gingivitis and epulis share characteristics such as localized gum
overgrowth around 1-2 teeth. However, epulis presents a distinct leaf or mushroom shape with a
reddish-brown or bluish hue. Bone changes, including thinning at the base of the epulis, are also
observed. Epulis often displays periodontal involvement near the causative tooth.
Periodontitis, as an independent disease entity within periodontal diseases, involves
inflammatory and destructive processes affecting all periodontal tissues.
Differentiating between acute and exacerbated chronic periodontitis relies on identifying shared
symptoms such as general malaise, tooth pain (especially during chewing or jaw clenching),
redness and swelling of the alveolar process lining, and often an abscess. Key distinguishing
factors include periodic appearance of single abscesses in different locations with a 5-7 day
interval. These abscesses are located at the attached gum, unconnected to periodontal pockets,
frequently draining through fistulas, and X-rays reveal predominant vertical bone pocket
resorption in the alveolar processes. The diagnosis of chronic periodontitis can be complex due
to overlapping symptoms with other conditions.
JOURNAL OF IQRO – ЖУРНАЛ ИҚРО – IQRO JURNALI – volume 14, issue 01, 2025
ISSN: 2181-4341, IMPACT FACTOR ( RESEARCH BIB ) – 7,245, SJIF – 5,431
ILMIY METODIK JURNAL
Distinguishing Chronic Periodontitis from Other Conditions:
Periodontosis Complicated by Inflammation: Both conditions share signs like gum redness and
swelling, periodontal pockets, plaque and tartar buildup, and tooth mobility. However, in
periodontosis complicated by inflammation, receding gums without pockets and wedge-shaped
bone defects are observed radiographically, alternating areas of increased and decreased bone
density.
Desmodontosis: Similar to chronic localized periodontitis, this condition presents with tooth
displacement, gaps between teeth, loosening, and periodontal pockets, as well as vertical bone
loss. However, desmodontosis lacks a clear local cause, involves symmetrical gum inflammation,
primarily affecting the front incisors and molars. Eosinophilic Granuloma: This condition shares
symptoms of bleeding gums, mobility of premolars and molars, and periodontal pockets with
chronic generalized periodontitis. However, eosinophilic granuloma lacks a local cause, presents
without pus drainage from the pockets, progresses rapidly over 1.5-2 months, and shows
characteristic oval or round bone resorption patterns on X-rays near tooth roots, jaw angle, or
ascending branch.
Severity Assessment: The severity of periodontitis is assessed based on the extent of alveolar
bone loss and the degree of tooth mobility.
Periodontosis vs. Involutional Changes:
Both conditions involve receding gums, tooth mobility, and bone loss. However, in involutional
processes, which occur with aging, gum recession and tooth mobility are uneven, varying in
severity. Additionally, tooth wear is present, and there's no evidence of widespread or localized
bone thinning (osteoporosis) in the jawbone on X-rays. This paraphrased version aims to clarify
the diagnostic challenges posed by overlapping symptoms while highlighting key distinguishing
features for each condition. In diagnosing periodontal diseases, it is crucial to consider not only
oral health but also systemic factors such as blood disorders and infectious diseases like syphilis
and tuberculosis. While advancements in diagnostic tools, particularly functional methods, have
greatly enhanced our understanding of periodontal pathology, these methods often lack the
specificity to differentiate between various forms of the disease.
Quantitative indices commonly used in periodontology provide limited insight into the complex
interplay of factors contributing to periodontal disease, including oral hygiene, gum
inflammation, vascular health, and bone changes. These indices primarily serve administrative
purposes related to insurance claims.
Furthermore, diagnosing tumor-like conditions within periodontal tissues presents a significant
challenge due to the necessity of histological confirmation. This requires the collection and
analysis of tissue samples by specialized laboratories, posing logistical difficulties for individual
dental practices.
Conclusion
. The microscopic analysis of tissue samples plays a crucial role in the
comprehensive evaluation of patients with periodontal disease. This procedure is essential for
determining the most appropriate and effective treatment strategy for these oral health conditions.
Literature
JOURNAL OF IQRO – ЖУРНАЛ ИҚРО – IQRO JURNALI – volume 14, issue 01, 2025
ISSN: 2181-4341, IMPACT FACTOR ( RESEARCH BIB ) – 7,245, SJIF – 5,431
ILMIY METODIK JURNAL
1. Bobur B. Sattorov, Nodira Sh. Nazarova. Scientific justification for planning the
organization of dental care for workers in contact with epoxy resin. Central Asian Journal of
Medicine, 2024. №2 Р 59-65.
2. Ризаев Ж.А., Назарова Н.Ш. Состояние местного иммунитета полости рта при
хроническом генерализованном парадонтите. Вестник науки и образования 2020. № 14 (92)
Часть 4. С 35-40.
3. Назарова Н.Ш., Рахманова Н.Р. "Состояние местного иммунитета полости рта при
хроническом генерализованном парадонтите". Достижения науки и образования - научно-
методический журнал, 2020, №6(60), стр. 65-71
4.
Назарова Н.Ш., Норбутаев А.Б., Исмаилова С.О. "Состояние твердых тканей зубов и
парадонта у работающих в табаководстве". Достижения науки и образования - научно-
методический журнал, 2020, №6(60), стр. 59-65.
5. Rizayev Jasur Alimdjanovich, Nazarova Nodira Sharipovna. Assessment Of Changes In
The Condition Of Periodontal Tissues In Workers Exposed To Exposure To Epoxy Resin. The
American journal of medical sciences and pharmaceutical research №2 Р 14-17.
6. Rustem Hayaliev, Sabir Nurkhodjaev, Nodira Nazarova, Jasur Rizayev,Rustam
Rahimberdiyev, Tatyana Timokhina, Ivan Petrov. Interdisciplinary Approach of Biomedical
Engineering in the Development of Technical Devices for Medical Research. Journal of
Biomimetics, Biomaterials and Biomedical Engineering Submitted: 2021-05, Vol. 53, pp 85-92
Accepted: 2021-05-11.
7. Ризаев Ж.А., Назарова Н.Ш. Состояние местного иммунитета полости рта при
хроническом генерализованном парадонтите. Вестник науки и образования 2020. № 14
(92). Часть 4. С 35-40.
8. Ризаев Ж.А., Назарова Н.Ш. Эффективность савокупного лечения болезней парадонта
и слизистой оболочки работающих с вредными производственныыми факторами.
Проблемы биологии и медицины.2020. №3 (119) . С 85-88.
9.
Н.Ш. Назарова, Т.А. Бердиев. Эпоксид смолалар таъсирига учраган ишчиларда
пародонтал тукималар холатининг узгаришини бахолаш. Жамият ва инновациялар. 2020,
октябрь. С 566-570.
10. Ризаев Ж.А., Назарова Н.Ш., Бердиев. Т.А. Шиша толали тузилмаларни ишлаб
чикариишда NBF гингивал гелининг самарадорлиги. Жамият ва инновациялар. 2020,
октябрь С 678-682.
11. Н.Ш. Назарова, Т.А. Бердиев. Эпоксид смолалар таъсирига учраган ишчиларда
пародонтал тукималар холатининг узгаришини бахолаш. Жамият ва инновациялар. 2020,
октябрь. С 565-569.
12. Ризаев Ж.А., Назарова Н.Ш., Бердиев. Т.А. Шиша толали тузилмаларни ишлаб
чикариишда NBF гингивал гелининг самарадорлиги. Жамият ва инновациялар. 2020,
октябрь. С 565-569.
13. Ризаев Ж.А., Назарова Н.Ш.. Эффективность савокупного лечения болезней
парадонта и слизистой оболочки работающих с вредными производственныыми
факторами. Проблемы биологии и медицины. 2020. №3 (119) . С 85-88.
14. Nazarova Nodira Sharipovna, Islomova Nilufar Bustanovna. Assessment of clinical and
morphological changes in the oral organs and tissues in post-menopause women. Frontline
medical sciences and pharmaceutical journal. Volume 02 Issue 05, 2022. Р. – 60-67.
15. Н.Ш. Назарова, Н.Б. Исломова. Postmenopauza davridagi ayollarda stomatologik
kasalliklarining klinik va mikrobilogik ko‘rsatmalari va mexanizmlari. Журнал медицина и
инновации. 2 (6), 2022. Р. – 204-211.
16. Н.Ш. Назарова, Ш.Ш. Шукуров. B va С surunkali virusli gepatitlarda surunkali tarqalgan
parodontit diagnostikasining klinik-morfologik asoslanishi. Журнал медицина и инновации. 2
(6), 2022. Р. – 118-123.
JOURNAL OF IQRO – ЖУРНАЛ ИҚРО – IQRO JURNALI – volume 14, issue 01, 2025
ISSN: 2181-4341, IMPACT FACTOR ( RESEARCH BIB ) – 7,245, SJIF – 5,431
ILMIY METODIK JURNAL
17. Н.Ш. Назарова, Ж.Б. Саидмурадова, И.Р. Равшанов. Патогенетические аспекты
заболеваний тканей пародонта при ортодонтическом лечении. Журнал медицина и
инновации. 2 (6), 2022. Р. – 183-191.
18. von der Hoeh N.H. et al. Total spondylectomy for solitary
19. bone plasmacytoma of the lumbar spine in a young woman: a
20. case report and review of literature. Eur Spine J., 2014 Jan,
21. vol. 23(1), pp. 35-39. Epub 2013 Aug 30.
22. 2. Schwartz T.H. et al. Association between intracranial
23. plasmacytoma and multiple myeloma: clinicopathological
24. outcome study. Neurosurgery, 2001 Nov, vol. 49(5), pp.
25. 1039-1044; discussion 1044-1045.
26. 3. Bencheikh R. et al. Solitary bony plasmocytoma of the
27. mandible. Rev Stomatol Chir Maxillofac., 2007 Apr, vol.
28. 108(2), pp. 135-138. Epub 2007 Mar.
29. 4. Canger E.M., Celenk P., Alkan A., Günhan O. Mandibular
30. involvement of solitary plasmocytoma: a case report. Med
31. Oral Patol Oral Cir Bucal., 2007 Jan 1, vol. 12(1), pp. E7-E9.
32. Epub 2007 Jan.
33. 5. Ferrer Albiach C. et al. Solitary plasmocytoma of the
34. mandible. Report of one case and review of the literature. An
35. Otorrinolaringol Ibero Am., 1995, vol. 22(6), pp. 609-618.
36. 6. Christensen R.E. Jr, Sanders B., Mudd B. Local recurrence.
