Management Of Gingival

Enlargement
- A CLINICAL CASE
REPORT
guided by:
dr. uzma khanam
DR. qurat ul AIN

Presented By:
Dr. Maliha Tahir
Dr. Humna Najeeb
(House Officers)

Department Of Periodontology
University Medical & Dental College, Faisalabad

Gingival
defined as

enlargement

is

an overgrowth or increase in
the size of gingiva.

Gingival enlargement is usually caused by

local
conditions such as poor oral
hygiene, food impaction, or mouth breathing.

The involved tissues are glossy, smooth, and

edematous
and bleed readily.
Loss of interseptal bone and drifting of the
teeth occur in long standing cases of
inflammatory enlargement.

Based on the etiological factors and pathological factors:

I. Inflammatory enlargement
a. acute
b. chronic
II. Drug induced enlargement
a. anticonvulsants (phenytoin, barbital, ethosuximide)
b. calcium channel blockers (nifedipine, amlodipine, verapamil)
c. cyclosporine, an immunosuppresant
III. Enlargements associated with systemic disease or conditions
Conditioned enlargement
a. pregnancy
b. puberty
c. vitamin C deficiency
d. nonspecific, such as a pyogenic granuloma

III. Systemic disease causing enlargement

leukemia
granulolomatous diseases
IV. Neoplastic enlargement
benign neoplasms, such as fibromas, papillomas and
giant cell granulomas
malignant neoplasms, such as a carcinoma or malignant melanoma
V. False enlargement

Degree of enlargement
Grade 0: No signs of gingival enlargement

Grade I: confined to interdental papilla

Grade II: involve papilla and marginal

gingiva

Grade III: enlargement covers three

quarters or more of the crown

Management
Management of gingival
hyperplasia depends on the cause
of the condition.
In general, reinforcement of good home
care oral
hygiene regimens and
periodic professional surgical excision of
gingiva are the treatments of choice.

Management

CASE REPORT

 A 26 year old lady came with a

complaint of painless gingival
overgrowth in the anterior upper
and lower arch.

Patient had gingivectomy 8 years ago but

the condition recurred a year after the
procedure.

Medical history
Systemic history

unremarkable

Any previous drug history

unremarkable
Past medical history
Family history

unremarkable
unremarkable

Clinical examination
The extra-oral examination:
Did not reveal any abnormality.

The intra-oral examination revealed:

localised, severe gingival enlargement involving
both
labial and lingual regions in the maxillary
and mandibular arches.

Investigations
Radiograp
h

lab diagnosis

Patients report showing normal blood profile

management
Differential Diagnosis:
Inflammatory gingival enlargement
Gingival hyperplasia due to mouth
breathing
Hormone induced gingival enlargement
Idiopathic gingival fibromatosis

Patient education:
Prognosis
Oral hygiene instructions
Dietary changes
Counselling

periodontal
(non surgical)

Treatment
plan

surgical

Periodontal (non surgical) procedure:

Scaling & deep curettage done under L.A

Surgical procedure:

Gingivectomy

Post-op instructions
Saline rinses for a week
Avoid hot drinks for 24 hrs
Avoid tooth brushing for 24 hrs
Enziclor mouthwash for 2 weeks.

Post-op wound infection prophylaxis:

Augmentin
Flagyl
Synflx

Follow-up visit
Biopsy result has not yet
arrived.

The patient is advised to

maintain a scrupulous oral
hygiene and is kept under
regular observation.

References
ClinicalPeriodontologyCarranza,Takei,Newman.10thedition.
JournalofClinicalPeriodontologyVolume21Issue4Page256259,April1994

UNILATERALGINGIVALENLARGEMENTACASEREPORTPravaraMedRev2010;2(2)