GINGIVAL ENLARGEMENT AND ITS TREATMENT : GINGIVAL ENLARGEMENT AND ITS TREATMENT By:
DENTAL HYGIENIST (Batch II)
(DENTAL CARE PROFESSIONALS)
DOW UNIVERSITY OF HEALTH SCIENCE(DUHS) GINGIVAL ENLARGEMENT : GINGIVAL ENLARGEMENT Gingival enlargement refers to excessive growth of the gums, and may also be known as gingival hyperplasia or hypertrophy. Gingival enlargement : Gingival enlargement The currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. This is strictly a clinical description of the condition and avoids the erroneous pathologic connotations of terms used in the past such as hypertrophic gingivitis or gingival hyperplasia. Gingival enlargement can be caused by a number of various stimuli, and "treatment is based on an understanding of the cause and underlying pathologic changes. What are the symptoms? : What are the symptoms? Gingival enlargement may cause discomfort, interfere with speech or chewing, result in halitosis (bad odour to the breath) and it may look unsightly CLINICAL CHARACTERISTICS: : CLINICAL CHARACTERISTICS: Normal gingiva Gingival enlargement Slide 7: Generalized enlargement of the marginal and interdental gingiva seen, this coronal enlargement of the gingiva causes an increase sulcular depth without apical migration of the junctional epithelium.
Enlargement is more pronounced the interdental gingiva areas. Clinical Characteristics: Slide 8: Tissue enlargement may progress to the point that the tissue obscures the teeth and may interfere with occlusion
Enlargement tissue appear firm fibrotic, pale pink and resilient, has little tendency to bleed, and has lobed surface appearance
Enlargement usually through out the mouth and appear more pronounced in the anterior area
If inflammation is present then tissue appears red or bluish red.
Bleeding tendency increases.
Enlargement affects areas in which teeth are present and rarely affects edentulous spaces.
Enlargement occurs more frequently in younger patients receiving the medication. Clinical Characteristics cont…. RADIOGRAPHIC SIGNS : RADIOGRAPHIC SIGNS No specific radiographic findings characteristics of this condition will because only the soft tissues are affected : Potential risk factors for drug-induced gingival overgrowth include the following:
Poor oral hygiene
Periodontal pocket depth
Degree of dental plaque
Duration and dose of cyclosporine RISK FACTORS CLASSIFICATION : CLASSIFICATION ETIOLOGIC FACTORS : ETIOLOGIC FACTORS INFLAMMATORY
C. ASSOCIATED WITH SYSTEMIC DISEASES OR CONDITIONS
1) conditions 2)diseases
D. NEOPLASTIC ENLARGEMENT
E. FALSE ENLARGEMENT Drug-induced enlargement : Drug-induced enlargement Gingival enlargement may also be associated with the administration of three different classes of drugs, all producing a similar response:.
anticonvulsants (such as phenytoin, phenobarbital, lamotrigine, valproate, vigabatrin, ethosuximide, topiramate and primidone)
calcium channel blockers, such as nifedipine and verapamil.the dihydropyridine derivative isradipidine can replace nifedipine and does not induce gingival overgrowth.
cyclosporine, an immunosuppresant. scurvy : Non-inflamed gingival enlargement tends to be a darker red or purple. It may be soft, which bleeds easily, or firm. It is also more likely to occur in those with poor dental hygiene. Causes include
Hormonal states: pregnancy, puberty;
Nutritional deficiency: scurvy (vitamin C deficiency);
Medications, most often cyclosporine, phenytoin and other anticonvulsants, calcium channel blockers. Uncommonly, it may be due to antibiotics, antidepressants and other medications. scurvy DRUG-INDUCED ENLARGEMENTcont…. Slide 15: Blood conditions such as acute leukaemia, lymphoma or aplastic anemia;
Systemic diseases most often Wegener granulomatosis, sarcoidosis, Crohn disease, Type 1 neurofibromatosis, primary amyloidosis, Kaposi sarcoma and acromegaly. DRUG-INDUCED ENLARGEMENTcont…. Slide 16: Enlargement associated with systemic factors
Many systemic diseases can develop oral manifestations that may include gingival enlargement, some that are related to conditions and others that are related to disease:
vitamin C deficiency
nonspecific, such as a pyogenic granuloma Slide 17: SYSTEMIC DISEASE CAUSING ENLARGEMENT
granulolomatous diseases, such as Wegener's granulomatosis and sarcoidosis
benign neoplasms, such as fibromas, papillomas and giant cell granulomas
malignant neoplasms, such as a carcinoma or malignant melanoma
FALSE GINGIVAL ENLARGEMENTS
There is no true enlargement
such as when there is an underlying bony or dental tissue lesion Slide 18: Genetic conditions,
Often present at birth (all rare conditions): hereditary fibromatosis, I-cell disease, mucopolysaccharidoses, fucosidosis, aspartyl glycosaminuria, Pfeiffer's syndrome, infantile systemic hyalinosis and primary amyloidosis. Localised gingival enlargement may be seen in Fabry's syndrome, Cowden's syndrome, tuberous sclerosis, Sturge-Weber angiomatosis and gingival granular cell tumour. TREATMENT : TREATMENT The treatment depends on the underlying cause. Gingivitis may improve with the following measures:
Removal of bacterial plaque by thorough tooth brushing and flossing
Antiseptic mouthwashes such as chlorhexidine
Courses of antibiotics to reduce oral bacterial load (e.g. erythromycin) TREATMENT cont…. : TREATMENT cont…. Drugs known to cause gingival enlargement should be discontinued. Gingivectomy (surgical removal of overgrown gum tissue) may be necessary for severe cases and may be repeated if necessary.