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Plasma cell gingivitis associated with nickel allergy: diagnostic challenges and patient management – a case report

British Dental Journal volume 240, pages 407–412 (2026)Cite this article

Abstract

This report aims to present the clinical features, treatment approach, and management guidelines for plasma cell gingivitis (PCG) associated with nickel allergy. A 63-year-old woman was admitted to the clinic with complaints of gingival overgrowth and bleeding. Anamnesis and clinical examination revealed that she had been wearing metal-based fixed prostheses for 15 years. A complete blood count was performed and, after excluding malignancy, histopathologic evaluation revealed a diagnosis of PCG. A skin patch test confirmed nickel allergy, supporting the suspected link between the gingival condition and prolonged exposure to nickel-containing dental prostheses. Nickel levels in gingival tissues were evaluated using atomic absorption spectroscopy (AAS) before and after removal of restorations. AAS measurements detected 6.6 μg/g of nickel before removal and no more than blank analysis afterward. Following phase one and surgical periodontal treatment, and systemic steroid therapy, zirconium-supported prostheses were fabricated. The patient's gingival tissues returned to a healthy condition. This case report shows that PCG related to nickel allergy is characterised by gingival overgrowth with a fiery-red appearance. To confirm clinical findings, histopathological evaluation should include nickel quantification whenever possible. Treatment options should prioritise the elimination of nickel-containing prostheses, with substitution by all-ceramic restorations, to achieve resolution and prevent recurrence.

Key points

  • Plasma cell gingivitis may represent an oral manifestation of nickel allergy and should be considered in patients with persistent, therapy-resistant gingival inflammation.

  • Accurate diagnosis requires a multidisciplinary approach, including careful exposure history and appropriate allergy testing.

  • Identification and elimination of the allergenic source can result in marked clinical improvement and help avoid unnecessary invasive procedures.

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Acknowledgments

The authors thank Prof Evşen Tamam for performing all stages of the patient's prosthetic treatment and for her valuable contribution to the evaluation of the case.

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Authors and Affiliations

  1. Department of Periodontology, Gazi University Faculty of Dentistry, Emek, Çankaya, Ankara, 06490, Turkey

    Zeynep Turgut Çankaya & Gülenay Çolak

  2. Department of Oral Pathology, Gazi University Faculty of Dentistry, Emek, Çankaya, Ankara, 06490, Turkey

    Emre Bariş & İpek Atak Seçen

  3. Faculty of Science, Department of Chemistry, Gazi University, Eti, Maltepe, Ankara, 06490, Turkey

    Özcan Yalçınkaya

Authors
  1. Zeynep Turgut Çankaya
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  2. Gülenay Çolak
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  3. Emre Bariş
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  4. İpek Atak Seçen
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  5. Özcan Yalçınkaya
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Contributions

All authors (ZTÇ, GÇ, EB, İAS, ÖY) have made significant contributions to this study. ZTÇ: conceptualisation (lead); supervision; writing – review and editing; methodology. GÇ: conceptualisation (supporting); writing – original draft preparation; visualisation. EB and İAS: histopathological analysis; investigation. ÖY: investigation. All authors have given final approval of the version to be published and agree to be accountable for all aspects of the work to ensure accuracy and integrity.

Corresponding author

Correspondence to Zeynep Turgut Çankaya.

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The authors declare no conflicts of interest related to this study, which was self-funded. Written consent to publish has been obtained for the publication of the case.

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Çankaya, Z., Çolak, G., Bariş, E. et al. Plasma cell gingivitis associated with nickel allergy: diagnostic challenges and patient management – a case report. Br Dent J 240, 407–412 (2026). https://doi.org/10.1038/s41415-025-9341-8

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