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Gingival enlargement, also termed gingival overgrowth, hypertrophic gingivitis, gingival hyperplasia, or gingival hypertrophy
Refers to an increase in the size of the gums.
It is a common feature of gingival disease.
Gingival hyperplasia can be caused by inflammatory conditions and the side effects of certain medications.
The treatment depends on the cause.
Causes:
Inflammatory
Drug induced
Enlargement associated with systemic diseases or conditions.
Neoplastic enlargement
False enlargement.
Inflammatory enlargement is most commonly due to chronic inflammatory gingival enlargement, when the gingivae are soft and discolored.
It is caused by tissue swelling and infective cellular infiltration caused by prolonged exposure to bacterial plaque
Inflammatory enlargement is treated with periodontal treatment, such as scaling and root planing.
It is often seen in mouth breathers, as a result of irritation brought on by surface dehydration.
The accumulation and retention of plaque is the chief cause of inflammatory gingival enlargement, and it is associated with poor oral hygiene, and physical irritation of the gingiva by improper restorative and orthodontic appliances.
Gingival enlargement may also be associated with three different classes of drugs.
It is a common side effect of phenytoin. and other anticonvulsants.
calcium channel blockers
cyclosporine, an immunosuppresant.
Of all cases of drug-induced gingival hyperplasia, about 50% are attributed to phenytoin, 30% to cyclosporins and the remaining 10-20% to calcium channel blockers.
In most cases of drug induced hyperplasia, discontinuing the drug resolves the hyperplasia.
Enlargement associated with systemic factors include:
pregnancy
puberty
vitamin C deficiency
nonspecific, such as a pyogenic granuloma
leukemia
granulolomatous diseases, such as granulomatosis with polyangiitis, sarcoidosis, or orofacial granulomatosis
neoplasm
benign neoplasms, such as fibromas, papillomas and giant cell granulomas
malignant neoplasms, such as a carcinoma or malignant melanoma
false gingival enlargements, such as when there is an underlying bony or dental tissue lesion
The initial management is improved oral hygiene, ensuring that the irritative plaque is removed from around the necks of the teeth and gums.
If there is chronic inflammatory gingival enlargement including a significant fibrotic component that does not respond to scaling and root planing, treatment with surgical removal of the excess tissue, with a gene gingivectomy.
In drug-induced disease, improved oral hygiene and plaque control is important to help reduce any inflammatory component that may be contributing to the overgrowth.
Reversing and preventing gingival enlargement caused by drugs requires ceasing drug therapy or substituting to another drug.