GINGIVAL ENLARGEMENT (GE) By Dr. Bangen Mohammed B.D.S., G.D.P., M.Sc. (Perio.

L-2

Gingival enlargement: Increase in the size of the gingiva. The terms (Gingival hypertrophy or gingival hyperplasia ) are NOT be used clinically.

Classification of gingival enlargement:

I- According to the Etiology & pathologic changes.

II- According to the location & distribution.

I- According to the Etiology & pathologic changes.

I- Inflammatory G.E. -acute -chronic II- Drug induced G.E. III- Idiopathic G.E. IV- Enlargements associated with systemic diseases A- conditioned enlargements Pregnancy Puberty Vitamin c deficiency Plasma cell gingivitis Nonspecific conditional enlargement (pyogenic granuloma) B-Systemic diseases - Leukemia - Granulomatous diseases ( Wegeners granulamatosis, sarcoidosis,..) V- Neoplastic G.E. (benign, malignant) VI- False G.E.

II- According to the location & distribution:

Localized: confined to single tooth or group of teeth. Generalized: involving gingiva through out the mouth. Papillary: confined to the interdental papilla. Marginal: confined to the marginal gingival. Diffuse: involving the papillae, marginal & attached gingivae Discrete: isolated sessile or pedunculated (tumor like) enlargement.

Degree of the GE is scored as followed:

rade 0: No signs of gingival enlargement. G Grade 1: Enlargement confined to interdental papilla. Grade 2: Enlargement involves papilla and marginal gingiva. Grade 3: Enlargement covers three quarters or more of crown.

I-Inflammatory enlargement: - Chronic

A- Forms

1- May be localized or generalized. 2- Discrete (tumor like ) enlargement. 3- Gingival changes associated with mouth breathing.
B- Etiology

1- May be localized or generalized. Clinically:

Originate as a slight ballooning of the IDP & gingival margin & can increase in size until it covers part of crown.

Progress slowly & painlessly unless complicated by infection or trauma.

2- Discrete (tumor like) enlargement: Clinically: - Sessile or pedunculated mass.

sessile (Wide base)

pedunculated (narrow base)

Cont. - Affect interproximal, marginal or attached gingiva.

- Grow slowly & painlessly.

- May undergo spontaneous

reduction in size followed by exacerbation & continued enlargement.

- Painful ulceration sometimes occurs in

the fold between the mass and the adjacent gingiva.

3- Gingival changes associated with mouth breathing:

- Both gingivitis & G.E. are seen. - Clinically:

- Gingiva red, edematous with diffuse shine. - Maxillary anterior region is the common site.

- The exact manner in which breathing affect

gingiva in not known.

- But the harmful effect is generally attributed to irritation from surface dehydration.

Etiology of chronic inflammatory G.E:

1- Prolonged exposure to dental plaque resulted from poor oral hygiene.

2- Factors that favor plaque accumulation and retention for examples: - Abnormal relationship between teeth. - Over hanging margin. - Food impaction. - Irritation from clasps. - Orthodontic therapy. - Habits, eg, mouth breathing.

Acute inflammatory G.E.:

1- Gingival Abscess: - Clinical Features - Etiology 2- Periodontal abscess:

Acute inflammatory enlargement: 1- Gingival Abscess: Clinically: The lesion is confined to the gingiva. It is sudden onset localized, painful & rapidly expanding lesion. Limited to the marginal gingiva or IDP. In early stages it appears as a red swelling with a smooth, shiny surface.

 Within 24 to 48 hours, the lesion usually becomes

fluctuant and pointed with expression of purulent exudate. The adjacent teeth are often sensitive to percussion.

Etiology of gingival abscess: 1- When the bacteria carried deep into the tissue.

2- When foreign substances (tooth brush bristle) forcefully embedded into the gingiva.

2- Periodontal abscess:

Generally produce enlargement of the gingiva, but

they also involve the supporting PD tissues.

Drug-induced G.E.:
The E. is fibrotic produced by drugs (other than

local factors) like anticonvulsants (Phenytoin), immunosuppressants (Cyclosporine), and calcium channel blockers (Nifedipine). Phenytoin Cyclosporine Nifedipine

 May create speech, mastication, tooth eruption, and

aesthetic problems.

The Clinical and microscopic

features of the enlargements caused by the different drugs are similar.

Clinical features:
Starts as painless bead-like enlargement (lingual,

facial gingival margin & IDP) united develop into massive tissue covering part of crown.

Cont. The lesion is mulberry shaped, firm, pale pink, and resilient, with a minutely lobulated surface and no tendency to bleed.

When complicated by local factors (inflammation)

add size to lesion & discolored to red or bluish-red & increased tendency toward bleeding.

Edentulous areas NOT involved.

 Idiopathic gingival fibromatosis

False enlargement

Idiopathic gingival fibromatosis:

Also terms as: ( gingivomatosis, diffuse fibroma,

familial elephantiasis, idiopathic fibromatosis). Rare condition.

Etiology:
Unknown, but may has hereditary base.

Enlargement occur with eruption of 1ry or 2ndry

dentition & may regress after extraction. local irritation is complicating factor.

Clinical features:
Affect the attached gingiva , gingival

margin & IDP. Buccal & lingual surfaces of max. & mand. are generally affected

 The E. may be limited to either jaw.

Enlarged gingiva is pink, firm, leathery

in consistency. In severe case teeth are completely covered.

False Enlargement: Not a true enlargements of the gingival tissues. Occur as a result of increases in size of the underlying osseous or dental tissues.
Clinical features are normal except there is

massive increase in the size of the area.

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