Gingival Enlargement Causes, Symptoms and Treatment

Gingival Enlargement Causes, Symptoms and Treatment

Gingival enlargement is usually caused by local conditions such as poor oral hygiene, food impaction or mouth breathing. Systemic conditions such as hormonal changes, drug therapy or tumor infiltrates may complicate the process or even set the stage for the development of unfavorable local conditions that lead to food impaction and difficulty with oral hygiene, functional and esthetic problems.

gingival enlargement

1.    Inflammatory Gingival Enlargement

Causes:-

  • Lack of oral hygiene
  • Common in adults, greater predilection during puberty
  • Females are affected more than males. Higher risk during pregnancy and treatment with oral contraceptive pills
  • Predisposing factors-Tooth crowding, mouth breathing, overhanging restorations, cervical cavities, orthodontic appliances

Symptoms:-

  • Diffuse involvement and ballooning of the marginal and papillary gingiva.
  • Glossy, smooth edematous gingiva with blunting of margins and fetid odour
  • Coral pink color of gingiva becomes light red
  • Loss of stippling
  • Bleeding on probing
  • Painful in acute stages

Treatment:-

  • Removal of causative factors, elimination of mouth breathing habit, oral prophylaxis
  • Use of anti-plaque agents-Chlorhexidine
  • Patient education for maintenance of oral hygiene

2.    Drug induced Gingival Enlargement

Cause:-

There is a positive correlation between poor oral hygiene anddrug induced gingival hyperplasia the enlaqrgement occurs after 1-3 months of initiation of treatment

Mainly 3 drugs are implicated

  • Predisposing factors- cyclosporine. It is an immunosuppressor. Cyclosporine causes epithelial interaction and leads to gingival enlargement.
  • Nifedipine-anti hypertensive drug
  • Dilantin (Phynytoin)- anti-epileptic drug. Phenytoin may induce a decrease in collagen degradation as a result of production of an inactive fibroblastic collagenase. Phynytoin increasesthe numbee ofcell surface EGFreceptori9n human gingival fibroblasts which contribute to alteration of gingival connective tissue.

Symptoms:-

  • Painless bead like granular enlargement
  • Mulberry shaped, firm, resilient, pale pink with a lobulated surface
  • It begins with the involvement of papillary gingiva and gradual lingual, facial and Occlusal extension cover the crowns of involved teeth interfering with speech and chewing
  • Stippli9ng present
  • Bleeding on probing if superimposed with inflammation

Treatment:-

  • Physician’s consultation for alternative drugs
  • Patient education and maintenance of oral hygiene
  • Gingivectomy and gingivoplasty
  • The enlarged gingiva spontaneously disappears after 3-6 months of discontinuation of the drug

3.    Leukemic gingival Enlargement

Monocytic leukemia has a greater tendency to present as gingival enlargement due to tumor infiltrations.

Symptoms:-

  • Diffuse, marginal or discrete tumour like masses due infiltration of leukemic cells
  • Fiery red, friable, boggy shiny edematous surface
  • Teeth may be completely covered
  • Localized infiltrations are greenish brown in color
  • Necrotic ulcerations of the gingiva, pallor and lymphadenopathy are characteristic features
  • Anemia and tendency for infections

Treatment:-

  • Oral hygiene instructions
  • Specific treatment-chemotherapy

4.    Scorbutic Gingival Enlargement

Cause:-

Vitamin C an essential nutrient for the development of intercellular substance and collagen synthesis can sometimes presenta typical picture of gingival enlargement. Such enlargement is a conditioned response to plaque.

Symptoms:-

  • Purplish spongy gingiva with a smooth shiny friable surface
  • Marginal gingiva is affected first
  • Absence of stippling
  • Bleeds easily with psuedomembrane formation
  • Involvement of connective tissue of the periodontal ligament of teeth may lead to their mobility
  • Subperiosteal and perifollicularhaemorrhage
  • Patients may complain of joint pain

Treatment:-

Vitamin C supplements

5.    Granulomatous Gingival Enlargement

Causes:-

Local/systemic diseases:

  • Crohn’s disease
  • Sarcoidosis wegners granulomatosis
  • Melkerson-Rosenthal syndrome
  • Allergy to food stuffs

Symptoms:-

  • Distinct small irregular, edematous bluish red swelling affecting the interdental papilla, marginal and attached gingiva
  • Loss of stippling
  • Associated painless labial and facial swelling is strongly associated with Melkerson-Rosenthal Syndrome

Treatment:-

This does not regress despite good oral hygiene and the mainstay o treatment is gingivectomy. Steroids

6.    Idiopathic gingival Enlargement

Symptoms:-

  • Usually occurs before 20 years of age
  • Exuberantfirm,painless enlargement leading to partial or fullcoverageofthe crowns of teeth, impeding their eruption and interfering withspeech and lip closure
  • Stippling present with numerous papill;ary projections and a pebbled surface and a leathery consistency
  • Marginal, attached and papillary gingivaare affected

Treatment:-

If gingivectomy does not help much, because of a tendency for recurrence, then extraction of teeth followed by dentures

 

 

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