Periodontology - Gingival Enlargement
Gingival enlargement is a common characteristic of gingival disease and is manifested as an increase in the size of the gums. Gingival enlargement can be caused by many different factors, and treatment depends on the cause, though hygienic measures are recommended in all cases of gingival enlargement. There are five general groups, classified by cause. These are inflammatory enlargement, drug-induced enlargement, enlargement associated with systemic diseases of conditions, neoplastic enlargement, and false enlargement.
Historically, gingival enlargement has been referred to as gingival hyperplasia and gingival hypertrophy. While gingival enlargement may, at times, be a manifestation of hypertrophy or hyperplasia, these are strict diagnoses related to the cellular anatomy of tissues and require microscopic analysis of tissue samples for definitive diagnosis. Hyperplasia is characterized by an increase in the number of cells, while hypertrophy is characterized by the increased size of individual cells. The only way to identify these conditions is through a microscopic evaluation of the tissue, which is not, traditionally, a part of diagnosis and which is also not necessary for accurate classification and treatment.
The most common cause of gingival enlargement is chronic inflammatory enlargement due to extended exposure to bacterial plaque. This exposure causes swelling, infection, and discoloration of the gingiva. The most common treatment for inflammatory gingival enlargement is periodontal treatment, which usually consists of scaling and root planing. The primary risk factor is poor oral hygiene, though inflammatory gingival enlargement can also be a result of physical irritation of the tissue by dental appliances or restorations. Inflammatory gingival enlargement may also be a result of irritation due to dehydration in mouth breathers, though the direct causes of this type of gingival enlargement are unclear.
Drug-induced gingival enlargement usually results from one of three different classes of drugs. These drug classes are anticonvulsants, calcium channel blockers, and an immunosuppressant called cyclosporine. About half of all cases of drug-induced gingival enlargement are related to the anticonvulsant phenytoin; 30% are related to cyclosporins, and the remainder are attributed to calcium channel blockers. Drug-induced gingival enlargement is believed to be associated with a genetic predisposition in certain patients, and it is unclear whether underlying inflammation is an integral part of drug-induced gingival enlargement. In most cases, when the drug is discontinued, the enlargement resolves.
Systemic diseases and conditions may develop gingival enlargement as a characteristic. Conditions related to gingival enlargement include pregnancy, puberty, vitamin C deficiency, and some nonspecific conditions. Diseases that lead to gingival enlargement include leukemia, granulomatous diseases, benign neoplasms, and malignant neoplasms; these neoplasms are associated with neoplastic gingival enlargement. Lesions of the bone or the dental tissue beneath the gums can also lead to gingival enlargements that are considered false gingival enlargements.
Regardless of the cause of gingival enlargement, improved oral hygiene is recommended to ensure that irritation is removed. When enlargement does not respond to periodontal treatment, this may necessitate a surgical procedure, called a gingivectomy, to remove excess tissue. In cases of drug-induced gingival enlargement, these hygiene techniques are recommended, along with modification of the drug treatment when possible.