4th L-2, Gingival Enlargement

7/27/2019 4th L-2, Gingival Enlargement

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GINGIVAL ENLARGEMENT (GE)

By

Dr. Bangen MohammedB.D.S., G.D.P., M.Sc. (Perio.)

L-2


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Gingival enlargement:

Increase in the size of the gingiva. The terms (Gingival hypertrophy or gingival

hyperplasia ) are NOT be used clinically.


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Classification of gingival enlargement:

I- According to the Etiology & pathologicchanges.

II- According to the location &distribution.


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I- According to the Etiology & pathologicchanges.


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I- Inflammatory G.E.

-acute

-chronicII- Drug induced G.E.III- Idiopathic G.E.IV- Enlargements associated with systemic diseases

A- conditioned enlargementsPregnancyPubertyVitamin c deficiencyPlasma cell gingivitisNonspecific conditional enlargement (pyogenicgranuloma)

B-Systemic diseases- Leukemia- Granulomatous diseases ( Wegenersgranulamatosis, sarcoidosis,..)

V- Neoplastic G.E. (benign, malignant)

VI- False G.E.


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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

gingivaeDiscrete: isolated sessile or pedunculated (tumor

like) enlargement.


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Degree of the GE is scored as followed:

Grade 0: No signs of gingival enlargement.

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.


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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


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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 complicatedby infection or trauma.


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2- Discrete (tumor like) enlargement:

Clinically:- Sessile or pedunculated mass.

sessile pedunculated

(Wide base) (narrow base)


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Cont.

- Affect interproximal, marginal or

attached gingiva.

- Grow slowly & painlessly.

- May undergo spontaneous

reduction in size followedby exacerbation &

continued enlargement.


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- Painful ulceration sometimes occurs in

the fold between the mass and theadjacent gingiva.


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3- Gingival changes associated with mouthbreathing:

- Both gingivitis & G.E. are seen.

- Clinically:

- Gingiva red, edematous with diffuse shine.

- Maxillary anterior region is the common site.


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-The exact manner in which breathing affect

gingiva in not known.

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


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Etiology of chronic inflammatory G.E:

1- Prolonged exposure to dental plaque resulted frompoor oral hygiene.


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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.


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Acute inflammatory G.E.:

1- Gingival Abscess:- Clinical Features

- Etiology

2- Periodontal abscess:


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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 asmooth, shiny surface.


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Within 24 to 48 hours, the lesion usually becomes

fluctuant and pointed with expression ofpurulent exudate.

The adjacent teeth are often sensitive topercussion.


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

2- When foreignsubstances (tooth brushbristle) forcefully

embedded into the

gingiva.


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2- Periodontal abscess: Generally produce enlargement of the gingiva, but

they also involve the supporting PD tissues.


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Drug-induced G.E.:

The E. is fibrotic produced by drugs (other thanlocal factors) likeanticonvulsants (Phenytoin),immunosuppressants (Cyclosporine), and calciumchannel blockers (Nifedipine).

Phenytoin Cyclosporine Nifedipine


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May create speech, mastication, tooth eruption, and

aesthetic problems.

The Clinical and microscopic

features of the enlargements

caused by the different drugsare similar.


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

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


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Cont.

The lesion is mulberry shaped, firm, pale pink, and

resilient, with a minutely lobulated surface and notendency 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.


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Idiopathic gingival fibromatosis

False enlargement


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Idiopathic gingival fibromatosis:

Also terms as: ( gingivomatosis, diffuse fibroma,familial elephantiasis, idiopathic fibromatosis).

Rare condition.


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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.


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Clinical features:Affect the attached gingiva , gingival

margin & IDP.

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


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The E. may be limited to either jaw.

Enlarged gingiva is pink, firm, leatheryin consistency.

In severe case teeth are completely

covered.


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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 ismassive increase in the size of the area.


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4th L-2, Gingival Enlargement

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