Quick Read
Gingival Enlargement also known as Gingival hyperplasia, Gingival hypertrophy, Gingival overgrowth, Hypertrophic gingivitis which is caused with the increase in the size of gingiva is called as gingival enlargement. Healthy gums are pale pink or pigmented, and wrap tightly around the neck of the teeth.
What is the effect of gingival enlargement?
Esthetic and functional problems will occur. Due to massive gingival enlargement, an affected person usually develops an abnormal swallowing pattern and experience difficulty in speech and mastication. Along with these features, there may be some interference with maintenance of oral hygiene. A cute pain associated with gingival enlargement leads to loss of mastication ability and difficulty in swallowing food. Gingival enlargement may leads to bad breath also.
Classification:
Based on location and distribution
- Localized:-
- Generalized:-involving the gingiva throughout the mouth
- Marginal:-confined to the marginal gingiva
- Papillary:-confined to the interdental papilla
- Discrete:-an isolated sessile or pedunculated tumor like enlargement
- Diffuse:-involving the marginal and attached gingiva and papilla
Based on the etiology it is classified into 5 types
- Inflammatory gingival enlargement
- Drug induced gingival enlargement
- Enlargement associated with systemic factors
- Neoplastic enlargement
- False enlargement
Inflammatory gingival enlargement:
Gingiva size increases due to inflammation. Gingival enlargement may result from chronic or acute inflammatory changes
Chronic inflammatory gingival enlargement:
causes are prolonged exposure to dental plaque, poor oral hygiene, irritation by anatomic abnormalities, improper restorative and orthodontic appliances.
Symptoms:
- Gingiva is tender, soft and red
- It is localized or generalized.
- Interdental, marginal, attached gingiva may involved
- Slow progressive and painless enlargement
- Painful ulceration may occur sometimes.
Acute gingival enlargement
causes are bacteria carried deep in to the tissues.
Symptoms
- Marginal and inter5dental gingiva are invo9lved
- Localized, painful, rapidly expanding within 24-28 hours lesion becomes fluctuant and purulent exudate expressed
Drug induced Gingival Enlargement:
The size of gingiva increases due to some drugs.
Causes:
- Anticonvulsants
- Phenytoin
- Phenobarbital
- Lamotrigine
- Valproate
- Calcium channel blockers
- Nifedipine
- Amlodipine
- Verapamil
- Immunosuppressant
- cyclosporine
Symptoms:
Enlarged gingiva is firm, non -tender
Pale pink in color
Do not bleed easily.
Associated with systemic factors:
It is divided into 2 types
- Conditioned enlargement
- Associated with systemic diseases
Conditioned enlargement:
Causes:
- Pregnancy:-enlargement in pregnancy also called as pregnancy tumor or pyogenic granuloma.
- Puberty
- Vitamin c deficiency
Associated with systemic diseases:
- Leukemia
- Granulomatous diseases such as Sarcoidosis, wegner’s granulomatosis
Neoplastic enlargement
Neoplastic enlargements are two types.
Benign-fibromas, papilloma, giant cell granulomas, gingival cyst, nevus
Malignant-Carcinoma, Malignant melanoma, Fibrosarcoma, Lymphosarcoma, Kaposis sarcoma
False gingival enlargement:
False gingival enlargement is seen when there is an underlying bony or dental tissue lesion
Scoring of gingival enlargement:
- Grade 0: no signs of gingival enlargement
- Grade 1: enlargement confined to interdental papilla
- Grade 2: papilla and marginal gingiva are involved
- Grade 3: enlargement covers three quarter or more of the crown
How to treat Gingival Enlargement?
Gingival enlargement can be caused by a number of various stimuli, and treatment is based on an understanding of the cause and underlying pathologic changes
- Oral hygiene: scaling and root planing to remove the plaque and calculus
- Adjust the improper restorations and orthodontic appliances
- Gingivectomy-surgical removal of hypertrophied gingiva.
- Lasers:Co2 lasers used for excision of gingiva
- Ceasing or substituting with another drugs to the drug induced gingival enlargement
- Use antiseptic mouthwash
Prevention:
- Mouth breathing should be treated earlier.
- Daily twice brushing
- Regular flossing
- Dental visits for every six months
