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Your Diagnosis Is Not The End But The Beginning Of Practise.

CLINICAL MANAGEMENT OF GINGIVAL ENLARGEMENT

DR. DEEPA PHILIPS UNDER THE GUIDANCE OF DR. NYMPHEA PANDIT DR. SHALINI GUGNANI, DR. DEEPIKA BALI. DEPT OF PERIODONTICS, D.A.V DENTAL COLLEGE, YAMUNANAGAR

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DEFINITION Increase in size of the gingiva. . Overexuberant response to a variety of local and systemic conditions.

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INFLAMMATORY ENLARGEMENT DRUG INDUCED ASSOCIATED WITH SYSTEMIC DISEASES /CONDITIONS ‡ CHRONIC ‡ ACUTE ‡ CYCLOSPORINE ‡ ANTIHYPERTENSIVES ‡ ANTICONVULSANTS ‡ CONDITIONED ENLARGEMENT ‡ SYSTEMIC DISEASES ‡ BENIGN ‡ MALIGNANT NEOPLASTIC ENLARGEMENTS FALSE ENLARGEMENTS .

LOCALISED GENERALISED MARGINAL PAPILLARY DIFFUSE DISCRETE .

EPULIS ‡Fibroma ‡Pyogenic granuloma ‡Peripheral giant cell granuloma ‡Peripheral ossifying fibroma METASTATIC LESIONS ‡DRUG INDUCED HYPERPLASIA ‡LEUKEMIC INFILTRATE ‡IDIOPATHIC ENLARGEMENT .

MAKING A DIFFERENTIAL DIAGNOSIS A good clinical history Surgical intervention .

SOFT AND EDEMATOUS FI OUS SCALING AND ROOT PLANING SURGERY SHRINKAGE MAINTENANCE GINGIVECTOMY FLAP SURGERY .

DISCONTINUATION/CHANGE OF MEDICATION ENLARGEMENT REGRESSES ENLARGEMENT PERSISTS ORAL HYGIENE RE INFORCEMENT RECALL PERIODONTAL SURGERY .

PERIODONTAL SURGERY SMALL AREAS OF ENLARGEMENT LARGE AREAS OF ENLARGEMENT ‡ OSSEOUS DEFECTS ‡ LIMITED KERATINISED TISSUE ‡ NO CLINICAL ATTACHMENT LOSS ‡ NO BONE LOSS ‡ ABUNDANT KERATINISED TISSUE GINGIVECTOMY FLAP SURGERY MAINTENANCE PHASE .

. physical or mental disorder. ‡ History excluded any epilepsy. ‡ Slow and progressively increasing in size .A CASE REPORT ‡ Chief complaint of swollen gums and bleeding from gums.

firm and of fibrous consistency and gave a pebbled appearance. ‡ It was pink in colour with a tendency to bleed and didn·t extend beyond the MGJ ‡ Grade III mobility present in relation to # 26 # 27.‡ ON EXAMINATION the enlargement was present on the left side involving maxilla and mandible which did not cross midline. . ‡ The gingiva was pale pink.

‡ History to exclude drug intake. ‡ Histopathology of the excised tissue.INVESTIGATIONS DONE. . ‡ Complete blood profile done to exclude any malignancy.

GENERALISED DIFFUSE IDIOPATHIC ENLARGEMENT .

IDIOPATHIC ENLARGEMENT ‡ Etiology not known ‡ Inheritance shows autosomal dominant trait in many cases. ‡ Presence of teeth thought to be the ´ INITIATING FACTORµ . ‡ Begins before the age of 20 and is correlate with the eruption of decidous and permanent teeth.

SURGICAL EXCISION .

AFTER HEALING .

Pre operative Post operative .

EXCISED TISSUE .

‡ Foci of necrosis and calcification also seen. ‡ Overlying epithelium showed thin elongated rete pegs extending into the fibrocollagenous tissue.HISTOPATHOLOGY ‡ Tissue showed dense fibrocollagenous tissue infiltrated with intense acute and chronic inflammatory cells. .

HISTOPATHOLOGY .

Haemostasis. Greater accuracy in making incisions. . Generates a coagulated tissue layer. Anticoagulant therapy patients. Minimal swelling and scarring.LASER GINGIVECTOMY ‡ ‡ ‡ ‡ ‡ ‡ Remarkable cutting ability.

ELECTROSURGERY ‡ Produces haemostasis. ‡ Thermal necrosis of surrounding zone due to production of latent heat. .

CONCLUSION ‡ Gingival enlargement may come to attention as a presenting complaint or an incidental finding. ‡ Cases of chronic inflammatory enlargement can just be treated by exquisite dental hygiene. . ‡ Its association with systemic diseases demands a diagnostic work up in a logical step wise approach.

. ‡ Idiopathic enlargement which persists despite aggressive oral hygiene needs to be considered for surgical reduction.‡ When it is medication related discontinuation or substituition is the gold standard. ‡ THIS SHOULD BE CONSIDERED AS A LAST LINE MEASURE.

Making a correct diagnosis is the first step in treating a case successfully«« .

THANK YOU«« .