Periodontology – Gingival Enlargement

Gingival enlargement occurs when the gingiva or gums have increased in their size. This condition is often associated with gingival disease. Numerous factors can cause gingival enlargement such as inflammatory conditions or a side effect of some medications. The cause of the condition will determine the treatment plan.

Classification

Historically, gingival hyperplasia and gingival hypertrophy have been the terms used to describe the condition. However, these terms are strictly a histologic diagnoses. A diagnoses for this type of condition requires a microscopic analysis of a tissue sample, making these terms an inaccurate description of gingival enlargement. The term hyperplasia refers to an increased number of cells, while hypertrophy refers to an increased size of individual cells. Because these identifications cannot be performed with a clinical examination and evaluation of the tissue, the term gingival enlargement is a more accurate term to use to describe the condition. Gingival enlargement has been classified according to cause and divided into the following groups:

  • Drug induced enlargement
  • Enlargement associated with systemic diseases or conditions
  • Inflammatory enlargement
  • False enlargement
  • Neoplastic enlargement

Causes

Inflammatory Enlargement

Gingival enlargement can be caused by various issues. The most common issue which causes the enlargement is chronic inflammatory gingival enlargement. This issues causes the gingivae to become soft and discolored. This is caused by tissue edema and infective cellular infiltration, caused by exposure to bacterial plaque. This condition is treated using conventional periodontal treatment, which often includes scaling and root planing.

Gingival enlargement and gingivitis are both commonly found in patients who breathers from their mouth. It results from irritation due to dehydration at the surface.

The chief cause of inflammatory gingival enlargement, however, is from the accumulation and retention of plaque. Risk factors for this can include poor oral hygiene practices, in addition to physical irritation of the gingiva from improper restorative or orthodontic appliances.

Enlargement from Systemic Factors

Many systemic diseases can develop oral manifestations, including gingival enlargement. Some of these are related to conditions or circumstances, while others which are associated with disease:

  • Pregnancy
  • Puberty
  • Vitamin C Deficiency
  • Systemic Diseases
  • 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

Management

The first solution recommended for treating gingival overgrowth is to follow an improved oral hygiene routine. The goal of this treatment is to ensure plaque is thoroughly removed from the teeth and gums. Situations where the chronic inflammatory gingival enlargement include a significant fibrotic component, which do not respond to scaling and root planing, are treated with surgical removal of the excess tissue. This procedure called a gingivectomy.

In cases of drug influenced gingival overgrowth (DIGO), improved oral hygiene and controlling plaque are still critical in reducing the inflammatory component contributing to the overgrowth. The reversal and prevention of gingival enlargement caused by a medication can simply require the patient to stop using the particular medication or using a substitution of the current medication for another drug which does not cause the side effect. These solutions are not always a viable option. Another solution includes alternative drug therapy, which can aid in avoiding this problematic side effect. In cases of immunosuppression therapy, tacrolimus is an available alternative which can result in far less severe gingival overgrowth compared to cyclosporine.