Magnification of an existing inflammation initiated by dental plaque 2. Pdf on jul 26, 2019, shruti bhatnagar and others published treatment of gingival enlargement find, read and cite all the research you need on. Pdf treatment of gingival enlargement researchgate. The enlargement can be inflammatory,fibrotic or a combination of both. It is an inheritable, clinically heterogeneous lysosomal storage disorder that develops due to a deficiency in the arylsulfatase b asb enzyme.
The accepted current terms for this condition are gingival enlargement and gingival overgrowth. According to medical history, the patient had received a kidney transplantation 2 years earlier 20. The treatment of gingival enlargement is based on an understanding of the cause and underlying pathologic changes of this condition see chapter 16. Management of druginduced gingival enlargement australian. Complications associated with gingival overgrowth may include retained primary teeth, delayed eruption of permanent teeth, increased distal spacing, d,, many cases are iatrogenic, some are. The differential diagnosis included enlargement due to drugs e. Nifedipineinduced gingival enlargement a systematic.
International journal of oral health dentistry, july september, 2015. Extramedullary involvement of leukemia can occur in up to 40% of patients. Introduction gingival enlargement is a common feature of gingival disease and may be caused by fibrous overgrowth or gingival inflammation or a combination of two. A customized decision tree is designed, which will help clinicians to keep a broad view when formulating a differential diagnosis of localized isolated, discrete, regional or generalized gingival enlargement and arrive at a particular diagnosis is an easy and systematic manner.
Lamy syndrome 11 this is another name for mucopolysaccharidosis vi mps vi. In july, 2015 the aap announced a focused update that addresses three. Drug induced gingival enlargement article pdf available in journal of chemical and pharmaceutical research 81. According to medical history, the patient had received a. Recognition and treatment of amlodipine norvasc induced gingival hyperplasia d. Appropriate management for the relief of symptoms of primary herpetic gingivostomatitis in an immunocompromised patient may include 1. Figure 1 it consists of creating bleeding points at the level of normal gingiva and then excising the tissue using a 45 degree external beveled incision.
Here, a case report of a gingival enlargement is presented that provided information for the diagnosis of post. Gingival enlargements are of special concern to the patient and the dentist because they pose problems that involve plaque control, function including mastication, tooth eruption, and speech, and aesthetics. It can also be inherited as in hereditary gingival fibromatosis. Thus, the aim of this study was to evaluate the incidence of digh using spontaneous reporting system srs databases.
Based on the existing knowledge and clinical experience, a differential. Of concern to the dental practitioner is the effect of these drugs on the gingival tissues. Gingival fibromatosis is a rare and heterogeneous group of disorders that develop as slowly progressive, local or diffuse enlargements within marginal and attached gingiva or interdental papilla. A case series shivanand aspalli, shirin a mulla, reetika gaddale and nagappa g department of periodontics and oral implantology, ames dental college and hospital, raichur, karnataka, india her medical history revealed epilepsy since the age of 3, controlled. Molecular and clinical aspects of druginduced gingival overgrowth. Calcium channel blockerinduced gingival enlargement. Pdf gingival enlargement is one of the frequent features of gingival diseases. Cyclosporineinduced gingival enlargement is more vascularized than phenytoin enlargement figures 1610 and 1611. Druginduced gingival hyperplasia digh causes problems with chewing, aesthetics, and pronunciation, and leads to the deterioration of the patients quality of life qol. Many types of gingival enlargements have been reported and can be classified according to etiologic factors and pathologic changes as inflammatory enlargement, enlargements associated with systemic diseases or conditions, neoplastic enlargements, and druginduced enlargement. Congenital gingival hyperplasia in a neonate with foetal valproate syndrome. In severe cases, the excess tissue may cover the crowns of the teeth, thus causing functional, esthetic, and periodontal problems, such as bone loss and bleeding, due to the presence of pseudopockets. Gingival enlargement during puberty has all the clinical features associated with chronic inflammatory gingival disease.
The degree of gingival overgrowth can be defined as. Signs and symptoms related to gingival enlargement are seen within 24 mo of initiation of drug intake. The mouth is frequently involved in conditions that affect multiple organs. Comparison between laser, electrocautery and scalpel in. Druginduced gingival overgrowth is a tissuespecific condition and is estimated to affect. Gingival enlargement the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. Calcium channel blockers and gingival overgrowth british. On intraoral examination, gradeiii generalized diffuse gingival enlargement was seen. Inflammatory gingival enlargement of labial anterior gin.
History revealed that initially the gingival overgrowth was minimal in size, and gradually it increased to reach up to present size. Gingival hyperplasia for a problem that is so common, there is really not very much in the veterinary literature on this odd condition, so it seems time for me to tell you a bit about my understanding of gingival hyperplasia, what brings it about, why it is a. An increase in size of the gingiva is a common feature of gingival disease. Jan 15, 2015 the treatment of gingival enlargement is based on an understanding of the cause and underlying pathologic changes of this condition see chapter 16. Gingival enlargement is an increase in the size of the gingiva gums. The possibility of druginduced enlargement was ruled out based on the medical history. Eponyms related to genetic disorders associated with gingival enlargement remarks maroteaux. Prevalence of gingival overgrowth induced by antihypertensive. Gingival enlargement is an overgrowth or increase in size of gingiva. The gingival morphology and tissue biotype have an influence on the likelihood of recession occurring.
These are strictly clinical descriptive terms, and they avoid the erroneous pathologic connotations of terms used in the past, such as hypertrophic gingivitis and gingival hyperplasia. When gingival tissues are enlarged, varying from mild enlargement of isolated interdental papillae to segmental or uniform and marked enlargement affecting one or both jaws, the tooth surfaces become difficult to access, inhibiting good oral hygiene and resulting in more inflammation and bleeding because enlarged gingival tissues. Interdisciplinary assessment and management of a patient with a. Gingival hyperplasia for a problem that is so common, there is really not very much in the veterinary literature on this odd condition, so it seems time for me to tell you a bit about my understanding of gingival hyperplasia, what brings it about, why it is a concern and how we manage it. Differential diagnosis, gingival hyperplasia, gingival overgrowth, gingival diseases, decision tree. To be considered a gingival enlargement resulting from medications, the size.
Patient was suffering from epilepsy and was under medication phenytoin sodium eptoin since last 10 10years. Gingival enlargement is one of the frequent features of gingival diseases. A complete examination of the oral cavity provides a gateway for an accurate diagnosis and precise management of many. A complete general examination with the help of additional diagnostic aids provided the diagnosis of post. There are several causes of gingival enlargement and they can be grouped into four categories. Gingival enlargement is one of the most important yet. Conventional versus laser gingivectomy in the management. Calcium channel blockers have been found to be responsible for a. Generalised fibrotic gingival enlargement in a psoriatic.
Many types of gingival enlargements have been reported and can be classified according to etiologic factors and pathologic changes as inflammatory enlargement, enlargements associated with systemic diseases or conditions, neoplastic enlargements, and druginduced. Dental plaqueinduced gingival conditions murakami 2018. The most common causes of localized gingival enlargement, which is defined as fibrous epulis, include subgingival plaque, tartar, and inappropriate restoration margins. A case report of gingival enlargement associated with. Gingival hyperplasia with unknown causes, not included in any groups, may also be seen. Gingival enlargement associated with systemic diseases many systemic diseases can develop oral manifestations that may include gingival enlargement these systemic diseases andor conditions can affect the periodontium by two different mechanisms as follows.
The effective and predictable management of gingival overgrowth requires correct diagnosis and consideration of aetiological factors, as discussed in part 1 2017. They can be categorized based on their etiopathogenesis, location, size, extent, etc. Gingival enlargement may result from the administration of 1. Idiopathic gingival enlargement and its management kumar p. Periodontal management of cyclosporin ainduced gingival. Thada, smitha rani and vineetha, r and pai, keerthilatha m 2015 generalised fibrotic gingival enlargement in a psoriatic patient. Idiopathic gingival enlargement and its management. Gingival enlargement or overgrowth is a clinical descriptive term for increases in size of gingiva. Aug 12, 2014 gingival enlargement associated with systemic diseases many systemic diseases can develop oral manifestations that may include gingival enlargement these systemic diseases andor conditions can affect the periodontium by two different mechanisms as follows. In clinical dentistry, patients frequently report with isolatedregional or generalized gingival enlargements, which could fall under varied presentations. Jun 20, 2018 the extent of gingival enlargements were defined as either localized or generalized. Gingival hyperplasia, fibrotic hyperplasia, vitamin c deficiency introduction gingival enlargement or gingival overgrowth, a common trait of gingival disease, is characterized by an increase in the size of gingiva 1,2.
Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement. Nifedipineinduced gingival enlargement sage journals. Individualized treatment plan for gingival enlargement. It is the degree of enlargement and the tendency to develop massive recurrence in the presence of relatively scant plaque deposits that distinguish pubertal gingival enlargement from uncomplicated. Gingival recession an overview sciencedirect topics. Niemiec, dvm davdc favd for decades, the beveled gingivectomy has been the standard for treatment of gingival enlargement. Gingival gum enlargement, also known as gingival hyperplasia or hypertrophy, is an abnormal overgrowth of gingival tissues. Systemic and clinical treatment of gingival hyperplasia. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. Localized gingival enlargements e321 introduction localized gingival enlargements lges are common in clinical practice 1,2 and are usually of reactive origin 1,2 developing as a response to chronic local irrita tion or trauma 3. She complained of esthetics, discomfort, and difficulties of plaque control. Feb 21, 2017 the enlargement can be inflammatory,fibrotic or a combination of both. This is strictly a clinical description of the condition and avoids the erroneous pathologic connotations of terms used in the past such as hypertrophic gingivitis or gingival hyperplasia. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications.
The oral cavity is considered an easily accessible window to the body. Gingival enlargement an overview sciencedirect topics. Vekaria, et al management of nifedipine induced gingival enlargement 50 journal of advanced oral research sepdec 2015 vol. One of the rarest sites of extramedullary involvement is the oral cavity, with only 5% or less of all patients with aml present with gum infiltration. Gingival recession can be defined as the displacement of the marginal tissue apical to the cementoenamel junction cej see aap glossary of terms. Gingival enlargement and its treatment authorstream. Idiopathic or hereditary gingival fibromatosis hgf is a relatively rare disease characterized by the enlargement of the gingiva, resulting in functional, esthetics and psychological disturbances. In recent years,flap surgery have been used more often to treat gingival enlargement than gingivectomy. Gingival enlargement a common feature of gingival disease which can be caused by gingival inflammation, fibrous overgrowth, or a combination of the two. Gingival enlargement may result from the administration of. Historical article eponyms related to genetic disorders.
The diagnostic dilemma of a granulomatous gingival enlargement. In many instances, oral involvement precedes the appearance of many other symptoms or lesions. Gingival enlargement is a condition that commonly develops during orthodontic treatment. Recurrent gingival enlargement, chronic periodontitis, dense fibrocollagenous tissue. Gingival enlargement is often associated with calcium channel blockers and ciclosporin. The diagnosis of these lesions is essential for their successful management and of the patient as a whole. Naik, ryschia r and carnelio, sunitha and natarajan, jayalakshmi and bhat, mahalinga k 2015 the diagnostic dilemma of a granulomatous gingival enlargement. Gingival hyperplasia in acute leukemia stanford medicine. The extent of gingival enlargements were defined as either localized or generalized. Comparison between laser, electrocautery and scalpel in the.
We analyzed reports of digh from srs databases and calculated the. Treatment of gingival enlargement pocket dentistry. In most cases, the enlargement results because of local irritations. Gingivitis classification is useful for diagnosis, prognosis and treatment planning. Article information, pdf download for molecular and clinical aspects of. The classification presented below is from development of a classification system for periodontal diseases and conditions by gc armitage, dds 1999 and is used by the american academy of periodontology aap. Treating patients with druginduced gingival overgrowth. This article revises the existing knowledge of different types of enlargements and highlights some important. Periodontal flap method for treatment of gingival enlargement. Rackley indiana university school of dentistry abstract assessment references 1. Gingival enlargement is a common clinical condition, usually associated with specific systemic conditions and variety of local factors. In severe cases, the excess tissue may cover the crowns of the teeth, thus causing functional, esthetic, and periodontal problems, such as bone loss and bleeding, due to. Complications associated with gingival overgrowth may include retained primary teeth, delayed eruption of permanent teeth, increased distal spacing, d.
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