Gingival Overgrowth

• hyperplasia?


  increase in size of tissue or organ due to increase in number of constituent cells
• hypertrophy?


  increase in size of tissue or organ due to increase in size of constituent cell
• overgrowth has replaced the term hyperplasia as swelling and enlargement is normally mixed/involving cell and extracellular matrix
• developmental examples

  • HGF type I and II
  • systemic juvenile hyalinosis
• inflammatory classification?


  inflammatory gingival hyperplasia
• drug induced?

  • phenytoin
  • nifedipine
  • ciclosporin
  • calcium channel blocking drugs
• blood dyscrasia?


  acute leukaemia
• granulomatous disorders?

  • Wegener's granulomatosis
  • Crohn's disease
  • Sarcoidosis
  • Coeliac's disease
  • Melkerson Rosenthal syndrome
• diagnosis considerations:

  • history identifies most likely diagnosis
  • blood test?
  • biopsy?
• HGF

  • hereditary gingival fibromatosis
  • rare, inherited
  • maillary tuberocites, mandibular retromolar pads
  • false pocketing/risk of attachment loss
  • thickened epithelium
  • prominent rete pegs
  • thick collegen fibres
  • management: gingivectomy, OHI
• IGO

  • inflammatory gingival overgrowth
  • occurs around puberty
  • false pocketing
  • collagen fibres, fibroblasts, inflammatory cells
  • TX: PMPR, OHI, deformities may required gingivectomy
• Phenytoin-induced gingival overgrowth

  • worst effected area on upper and lower anterior teeth
  • firm and fibrous
  • proliferation of fibroblasts and increased collagen production
  • regrowth common
  • ohi
  • drug substitution
• ciclosporin-induced gingival overgrowth

  • anti-rejection drug
  • thickened epithelium, increased vascular connective tissue
  • overgrowth arises 3m after taking medication
  • OHI, subgingival irrigation with CHX, new medication?
• gingival enlargement in acute leukaemia?

  • persistent gingival bleeding and overgrowth
  • good OH, chemical plaque control CHX
• Wegener's Granulomatosis

  • rare systemic disorder
  • necrotising and granulomatous vasculitis
  • ulcers on tongue, palate, gingival tissue, hyperplastic gingivitis
  • tx: prednisolone and cyclophosphamide
• Orofacial Granulomatosis:

  • linked to Crohns, sarcoidosis, TB, leprosy, hypersensitivity
  • labial and facial swelling
  • angular chelitis, broad band gingival inflammation and swelling
  • mucosal tag, ulcerations, cobblestone mucosa
• Malignant neoplasms

  • rare
  • squamous cell carcinoma
  • Kaposi's syndrome
  • lymphonams
  • metastatic tumours