Quick Read
We generally have a question, why do my gums bleed when I brush my teeth. Here we come with a detailed explanation about this bleeding gums.
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.
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 odor
- 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 and drug-induced gingival hyperplasia the enlargement 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 (Phenytoin)- anti-epileptic drug. Phenytoin may induce a decrease in collagen degradation as a result of the production of an inactive fibroblastic collagenase. Phenytoin increases the number of cell surface EGFreceptori9n human gingival fibroblasts which contribute to the alteration of gingival connective tissue.
Symptoms:-
- A 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 tumor-like masses due to 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 present a 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 pseudomembrane formation
- Involvement of connective tissue of the periodontal ligament of teeth may lead to their mobility
- Subperiosteal and perifollicular hemorrhage
- 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 foodstuffs
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 full coverage of the crowns of teeth, impeding their eruption and interfering with speech and lip closure
- Stippling present with numerous papillary projections and a pebbled surface and a leathery consistency
- Marginal, attached and papillary gingiva are affected
Treatment:-
If gingivectomy does not help much, because of a tendency for recurrence, then extraction of teeth followed by dentures
