Gingival Enlargements Overview

Gingival Enlargements

• Definition: An increase in the size of the gums, or excessive gum growth.
• Classification by Location: Localized, generalized, marginal.
• Classification by Distribution: Papillary, diffuse, isolated.
• Gingival Enlargement Grades:
  • Grade 0: No enlargement.
  • Grade I: Enlargement limited to interdental papilla.
  • Grade II: Enlargement includes papilla and marginal gingiva.
  • Grade III: Enlargement covers more than three-quarters of the crown.
• Normal Gingiva: Light pink color, strip-like shape, distinct from the redder vestibular mucosa.
• Gingivitis: Local irritations (plaque, tartar, poor restorations, poor hygiene) can be causes. -Infective Gingivitis: Infection (like streptococcus) causes intense leukocyte infiltration, edema, redness, swelling, and pain in the gingiva. Antibiotics are used for treatment.
• Focal Hyperplastic Gingivitis: Firm, fibrous, enlarged gingiva, often covering the teeth's crowns. Hormones (estrogen) related, seen in puberty and pregnancy. Occurs in the interdental papilla.
• Irritation Fibroma (Focal Fibrous Hyperplasia): A harmless lesion that's seen on gingiva, lips, buccal mucosa, and tongue edges, with no color change. Can last for years. Histological examination is necessary for diagnosis, and removal via excision is the treatment.
• Peripheral Ossifying Fibroma: Fibrous proliferation potentially originating from the periosteum or periodontal ligament, and sometimes contains bone and/or cementum. More common in women; recommended excision.
• Pyogenic Granuloma: Tumor-like, spherical, ulcerated, and red lesion on the gingiva, with possible purulent exudate. Usually responds favorably to surgical excision.
• Peripheral Giant Cell Granuloma: Pedunculated (attached) or wide-based lesion on the gingiva. Similar histologic appearance to central giant cell granuloma (if in bone). Surgical excision is the treatment.
• Atypical Gingivitis (Plasma Cell Gingivostomatitis): Marginal and attached gingiva, red, friable, easily bleeding.
• Inflammatory Fibrous Hyperplasia (Epulis Fissuratum): Irritation from ill-fitting dentures, typically affects the upper and lower buccal and labial vestibules. Easily bleeds, common in elderly patients..

Additional Gingival Conditions

• C-Vitamin Deficiency: Marginal gingivitis, bleeding, pseudomembrane formation, widespread edema, collagen degeneration.
• Gingivitis in Mouth Breathers: Anterior gingiva, swollen, red, dry, shiny appearance in young people.
• Drug-Induced Gingival Enlargements: Phenytoin (Dilantin), cyclosporine, nifedipine can cause gingival enlargement. Dental plaque and gingival irritation can exacerbate these enlargements. Often widespread and firm. Treatment: managing oral hygiene, local treatment often recommended.
• Hereditary Gingival Fibromatosis: Diffuse gingival hyperplasia; other anomalies (e.g. cornela dystrophy, deafness, nail defects, craniofacial anomalies) and other symptoms (often in children). Treatment: gingivectomy.
• Malignant Fibrous Neoplasms: Aggressive lesions (fibrosarcoma and malignant fibrous histiocytoma) that can originate in bone, especially the mandible or maxilla. Treatment is often radical excision, or jaw resection.
• Leukemic Hyperplasia: A severe, acute blood disorder that involves fever, fatigue, and possible lymph node swelling. Petechial bleeding and death are potential outcomes.
• Other Considerations:
  • Teeth treatment (e.g. implants) should be planned before chemotherapy.
  • Oral hygiene should be maintained.
  • Diet should be regulated.

Additional Oral/Tongue Conditions

• Angular Cheilitis: Painful fissures at the corners of the mouth, often bilateral. Associated with denture stomatitis, glossitis, systemic and local conditions, as well as age (over 50).
• Actinic Cheilitis: Epithelial atypia (tissue changes), hardness, crusts on the lower lip, may cause cancer development. Chronic stage marked by atrophy and keratosis over the entire lower lip. Vermilion border often disappears.
• Contact Cheilitis: Irritation and peeling on the lips due to substances like lipsticks, medications, toothpastes, and foods. Allergic reaction.
• Exfoliative Cheilitis: Fissures, desquamation, and hemorrhagic crusts on the lips. Commonly affected area is the middle of the lower lip. Associated with conditions like candidiasis, oral sepsis, stress. Treatment focuses on eliminating predisposing factors, antifungal ointments, and/or tranquilizers.
• Geographic Tongue: Inflammatory condition resulting in desquamation of filiform papillae on the tongue, leaving red patches. Sometimes, spontaneous remission or recurrence occurs. Common cause-unknown; it can be associated with stress, nutritional deficiencies, or heredity.
• Hairy Tongue: Papillae elongation, sometimes causes discoloration (white, black). May be related to smoking, certain foods, medications. Symptom-based issue.
• Median Rhomboid Glossitis: Red or red-white, flat or nodular lesion on the midline of the dorsal tongue. Generally asymptomatic.
• Condyloma Acuminatum: Multiple raised wart-like lesions on the tongue's dorsum.
• Tongue Paralysis(Glossoplegia): Often caused by central nervous system lesions, like tumors or strokes. Protruded tongue deviates toward the unaffected side.
• Tongue Spasm and Tremor: Tremors caused by innervation from facial nerves. Associated with general paralysis.
• Tongue Anesthesia: May be caused by trauma, infections, or nerve injuries during dental procedures. Symptoms may include numbness and burning.
• Tongue Paresthesia: Irritation of the lingual nerve, often causes numbness, burning sensation, or tingling.
• Tongue Pain (Glossodynia): Pain and burning sensation in the tongue. Caused by various factors: Nutritional deficiencies, anemia, oral cancer phobia, or galvanic currents.
• Taste Disorders: Reduced or lost taste sensation. Peripheral or central damage, possibly related to diseases affecting the tongue, nose, or middle ear.

This quiz covers the essential aspects of gingival enlargements, including definitions, classifications by location and distribution, and the grades of enlargement. Additionally, it discusses the causes of gingivitis and focal hyperplastic gingivitis, as well as the normal characteristics of healthy gingiva.