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Causes and Complications of Gingival Overgrowth in children
Gingiva or gums surround the teeth and provide a seal around them. Healthy gingiva appears in coral pink color, but may contain melanin pigment. Gingiva is divided into free gingiva, attached gingiva and interdental papilla. Free gingiva is terminal edge of gingiva surrounding the teeth in collar like fashion. Attached gingiva is continuous with free gingiva and it is firm, resilient tightly bound to the underlying alveolar bone. Interdental papilla is in pyramidal shape and it occupies the interproximal space beneath the area of tooth contact.
Gingival overgrowth also called as gingival hyperplasia or gingival hypertrophy or hypertrophic gingivitis. Gingival overgrowth is the enlargement of attached gingiva due to increased number of cells. Gingival overgrowth can be initiated by factors such as mouth breathing, irritations along the neck of the tooth or hormonal changes such as those at puberty. The most prevalent types of gingival overgrowth in children based on the cause are
- Drug induced gingival hyperplasia
- Hereditary gingival fibromatosis
- Neurofibromatosis
Drug induced gingival hyperplasia:-
Certain drugs can cause gingival overgrowth. These drugs are
- Cyclosporine-it is given to depress the immune system
- Nifedipine and amlodipine-these are used to treat hyper tension
- Phenytoin- used to treat epilepsy
Gingival hyperplasia will occur due to increase in the connective tissue extracellular matrix. It is more prevalent in male children and adolescents. Drug induced gingival hyperplasia can cause functional difficulties, disfigurement and delayed permanent teeth eruption.
Hereditary gingival Fibromatosis:-
It is also called as Von recklinghausen disease. It is most common syndromic gingival enlargement in children. It is an autosomal dominant disease. It usually appears at the time of permanent teeth eruption. Histologically it contains highly collagenized connective tissue. It can
cause drifting of teeth, retention of primary teeth, Diastema and poor plaque control.
Neurofibromatosis 1:-
It is an autosomal dominant disease. It is seen more common in mentally handicapped individuals. Gingival overgrowth is caused by the formation of plexiform neurofibromas in the connective tissue of the gingiva. These plexiform neurofibromas consist of hypertrophic nerves arranged as lobules in the connective tissue. Occasional malignant transformation may occur
Gingival Overgrowth associated with Syndromes:-
Gingival overgrowth is seen in syndromes that are
- Rutherfurd syndrome
- Cross syndrome
- Romon syndrome
- Haband syndrome
What are the complications of gingival overgrowth in children?
- Retained primary teeth or baby teeth
- Delayed the eruption of permanent teeth
- Poor plaque control
- Drifting of teeth
- Diastema is a gap between two teeth. It appears most often between the two upper front teeth
- Increased distal spacing
- Difficulty with chewing
- Change in the facial appearance due to lip protrusion
- Affects the normal closure of the lips
- Emotional distress
- Increased risk of caries
- Malocclusion
- It can also affects the speech of a child
How to Manage Gingival hyperplasia in children?
Dentist consultation is necessary for the treatment of gingival overgrowth. Mild gingival hyperplasia can be treated by professional scaling. Effective plaque control can reduce and prevent the gingival enlargement. Drug induced gingival enlargement can be treated by changing the drug or decreasing the dose of drug. Severe gingival enlargement can be treated by gingivectomy. It is a surgical procedure in which excess gingival tissue is removed. Mouth breathing, hormonal alterations should be treated. Gingival hyperplasia associated with syndrome needs both systemic and dental treatment. Daily twice brushing, regular flossing and regular dental visits provide good oral hygiene.
