Gingival enlargement

GINGIVAL ENLARGEMENTMaryam ArbabHouse OfficerDepartment Of PeriodonticsSBDC

INTRODUCTION -DEFINITION -CLASSIFICATION -GRADINGINFLAMMATORY GINGIVAL ENLARGEMENTDRUG-INDUCEDIDIOPATHICENLARGEMENTS ASS. WITH SYSTEMIC DISEASES

CONTENTS

NEOPLASTIC

FALSE ENLARGEMENT

TREATMENT

INTRODUCTIONDEFINITION Increase in the size of gingiva is called as gingival enlargement (Gingival overgrowth).

Carranzas 11 th edition

CLASSIFICATIONAccording to etiologic factors and pathologic changes 1. Inflammatory enlargement a. Chronic b. Acute 2. Drug-induced enlargement 1.Anticonvulsants 2.Immunosuppressants 3. Calcium channel blockers

3. Enlargements associated with systemic diseases or conditions :

A) Conditioned enlargement

i) Pregnancy

ii) Puberty

iii) Vitamin C deficiency

iv) Plasma cell gingivitis

v)Non specific conditioned enlargement (pyogenic granuloma)

B) Systemic diseases causing gingival enlargement i) Leukemia ii) Granulomatous disease (Wegeners granulomatosis, sarcoidosis)

4.Neoplastic enlargementBenign tumorsMalignant tumors

5.False enlargement

According To Location And Distribution

LOCALIZEDGENERALIZED

Degree Of Gingival EnlargementGrade 0- No signs of gingival enlarement

Grade 1- Enlargement confined to interdental papillaGrade 2- Enlargement involves papilla and marginal gingiva

Grade 3- Enlargement covers three quarters or more of the crown

CHRONIC INFLAMMATORY ENLARGEMENTACUTE INFLAMMATORY ENLARGEMENT(GINGIVAL ABSCESS)CLINICAL FEATURES-Ballooning of interdental papilla & marginal gingivaLocalized or generalizedProgresses slowly & painlesslySite- Interdental papilla, marginal & attached gingivaCLINICAL FEATURES-Localized, painful, rapidly expanding lesionsLesion becomes fluctuant & pointed with surface orifice within 24-48 hrsSite- Limited to marginal gingiva or interdental papillaETIOLOGY-Prolonged exposure to dental plaquePoor oral hygieneAnatomic abnormalitiesImproper restorative & orthodontic applianceETIOLOGY-Bacteria carried deep into tissues with a foreign substance forcefully embedded into gingiva

TYPES OF GINGIVAL INFLAMMATORY ENLARGEMENT

DRUG-INDUCED GINGIVAL ENLARGEMENT :Gingival enlargement is a well known consequence of administration of drugs such as

Anticonvulsants

Immunosuppressants

Calcium channel blockers

Clinical features-

Painless, beadlike enlargement of the interdental papilla and extends to facial and lingual gingival margins

Maxillary & mandibular anterior regionsWhen uncomplicated by inflammation is mulberry shaped, firm,pale pink, and resilient , with a minutely lobulated surface and no tendancy to bleedProject from beneath the gingival margin

SYSTEMIC USETreatment of all forms of epilepsy except petit malPrevent organ transplant rejection & several autoimmune diseasesTreatment of cardiovascular conditions such as hypertension, angina pectoris & cardiac arrythmiasDRUGS SPECIFIC TO CAUSE GINGIVAL ENLARGEMENTPhenytoinCyclosporineNifedipinePATHOGENESISPhenytoin stimulatesproliferation of fibroblasts like cells and epitheliumFormation of abundant extracellular matrix as a hypersensetivity responsePREVALENCEGingival enlargement occurs in 50% of patients receiving phenytoinCyclosporine causes gingival enlargement in 25%-70% patientsNifedipine induces gingival enlargement in 20% of patients

DRUGS ANTICONVULSANTS IMMUNOSPRESSANTS Ca CH.BLOCKER

IDIOPATHIC GINGIVAL ENLARGEMENTRare condition of undetermined cause.

CLINICAL FEATURES--Affects the attached gingiva as well as the gingival margin and interdental papilla-Involment is limited to the either jaw

-Enlarged gingiva is pink, firm and almost leathery in consistency

-Characterstic minutely pebbled surface

ENLARGEMENTS ASSOCIATED WITH SYSTEMIC DISEASESSystemic diseases and conditions can affect the periodontium by two different mechanisms-

Magnification of an existing inflammation initiated by dental plaque (conditioned enlargement)

Manifestation of the systemic disease independently of the inflammatory status of the gingiva.

CONDITIONED ENLARGEMENT HORMONAL Vit.C DEFICIENCY ALLERGICCLINICAL FEATURESGeneralizedProminent interproximallyBright red or magentaSoft and friable & has smooth & shiny surfaceBleeds spontaneouslyCLINICAL FEATURESMarginalBluish redSoft & friable & smooth & shiny surfaceSpontaneous bleedingSurface necrosis with pseudomembrane formationCLINICAL FEATURESFrequent in women & young adultsLocated on oral aspect of attached gingiva & therefore differs from plaque induced gingivitis.

Females are affected more than malesCommon age of occurrence is 11-40 yrsIts size ranges from 0.9- 2 cm.Asymptomatic, may be Papular or nodular Polypoid mass.It may become mature and become less vascular and more collagenous gradually converting into a fibrous epulis.

CLINICAL FEATURESNON SPECIFIC CONDITIONED ENLARGEMENT (PYOGENIC GRANULOMA)

16

Surface is commonly ulcerated and shows tendency to hemorrhage upon slightest pressure or trauma. Variegated red and white pattern. Lesions are pedunculated or sessile masses with smooth lobulated or even warty

SYSTEMIC DISEASES CAUSING GINGIVAL ENLARGEMENTGRANULOMATOUS DISEASE (WEGENERS GRNULOMATOSIS)

CLINICAL FEATURESLeukemic enlargement may be diffuse or marginal localized or generalized.The gingiva becomes soft, edematous and swollen.Appearance of gingiva is purplish and glossy.There is also pallor in the surrounding mucosa. Ulceration pain and severe hemorrhage can also occur.It has a spongy consistency and bleeds frequently.CLINICAL FEATURESIt involve the orofacial region and include oral mucosal ulceration, gingival enlargement, abnormal tooth mobility, exfoliation of teeth, and delayed healing response.

Strawberry gums appearance of the mandibular gingiva is commonly seen.

Enlargement is reddish purple and bleeds easily on stimulation but the condition is considered an

LEUKEMIA

NEOPLASTIC ENLARGEMENT(GINGIVAL TUMORS) BENIGN

Fibroma

Papilloma

Peripheral giant cell granuloma

Central giant cell granuloma

Leukoplakia

Gingival cyst MALIGNANT

Carcinoma

Malignant melanoma

BENIGN TUMORS

FIBROMAPAPILLOMAPERIPHERAL GIANTCELL GRANULOMAGINGIVAL CYST

MALIGNANT TUMORSCLINICAL FEATURESCommon in 5th and 6th decade of life.Carcinoma of mandibular gingiva is more common The fixed gingiva is invaded more than the free gingiva.It usually occurs in premolar area.Quickly spreads from gingiva to alveolar boneCLINICAL FEATURESMalignant melanoma is a rare oral tumor that tends to occur in the hard palate and maxillary gingiva of older persons.It is usually darkly pigmented and is often preceded by localized pigmentation.It may be flat or nodular and is characterized by rapid growth and early metastasis.It arises from melanoblasts in the gingiva, cheek, or palate.

CARCINOMAMALIGNANT MELANOMA

FALSE ENLARGEMENT

UNDERLYING OSSEOUS LESION

Enlargement of the bone subjacent to the gingival area occur most often in tori and exostoses.

It can also occur in pagets disease, fibrous dysplasia, cherubism, central giant cell granuloma, ameloblastoma, osteoma and osteosarcoma.UNDERLYING DENTAL TISSUES

During various stages of eruption particularly of the primary dentition, the labial gingiva may show a bulbous marginal distortion caused by superimposition of the bulk of the gingiva on the normal prominence of the enamel in the gingival half of the crown.

TREATMENT

TREATMENT PLAN

GINGIVECTOMYMethods of external bevel gingivectomy

THANK YOU !!

26