gingival enlargement

(gingival overgrowth, hypertrophic gingivitis)

An increase in the size of the gingiva (gums).

(Types)
• Inflammatory enlargement (most common)
• Drug induced enlargement
• Enlargement associated with systemic conditions or diseases

(Types: Inflammatory enlargement)
Tissue edema and infective cellular infiltration.
Gingivitis. The gingivae are soft and discolored.
(Causes)
• Accumulation and retention of bacterial plaque.
(Risk factors)
• poor oral hygiene: Bacterial plaque.
• physical irritation: Iimproper restorative and orthodontic appliances, surface dehydration by mouth breathing.
(Treatment)
• conventional periodontal treatment: Scaling and root planing or gingivectomy (surgical removal of the excess tissue). Improve oral hygiene.

(Types: Drug induced enlargement)
Caused by administration of drugs.
(Causes)
• anticonvulsants: Phenytoin (most common), phenobarbital, lamotrigine, vigabatrin, ethosuximide, topiramate, and primidone. Not common for valproate.
• immunosuppressant: Cyclosporine (second most common). Much less severe for tacrolimus (but it is nephrotoxic).
• calcium channel blockers (antihypertensives): Nifedipine (dihydropyridine class), amlodipine, and verapamil. Not for isradipine (dihydropyridine class).
(Treatment)
• Ceasing culprit drug or substituting to another drug.

(Types: Enlargement associated with systemic conditions or diseases)
Some are related to systemic conditions and others, diseases.
(Causes)
• Systemic conditions: Pregnancy, puberty, vitamin C deficiency, nonspecific (e.g. pyogenic granuloma).
• Systemic diseases: Leukemia, granulolomatous diseases (e.g. granulomatosis with polyangiitis, sarcoidosis, orofacial granulomatosis), neoplasms (neoplastic enlargement) (e.g. fibromas, papillomas, giant cell granulomas, carcinoma, malignant melanoma), underlying bony or dental tissue lesion (false enlargement).

(Comparison)
• epulis: The lump situated on the gingiva locally.
• gingival enlargement: The enlargement is over the whole gingiva.

Cf. gingivitis, periodontitis