Gingival Overgrowth Overview

Gingival Overgrowth

• Gingival overgrowth is a condition involving enlargement of the gums.
• It is often associated with specific medications (Calcium Channel Blockers, Anti-Convulsants).
• Identifying clinical features is important for diagnosis.
• Classifying gingival overgrowth is crucial (Papillary, Generalised, Discrete, Diffuse).
• Drug-induced gingival overgrowth is a significant concern.
• Potential causative factors need to be categorized for effective management.
• Assessment methods for patients with gingival overgrowth should be selected.
• Impact on oral health and well-being of the patient should be evaluated.
• Management strategies/recommendations should be given.

Definitions

• Hyperplasia: An increase in the number of cells.
• Overgrowth: An increase in the size of tissue.
• Cellular hyperplasia: An increase in the number of individual cells.
• Cellular hypotrophy: An increase in the size of individual cells.
• Diffuse: Occurring throughout the mouth.
• Discrete: Occurring in specific areas.
• Papillary: Confined to the interdental papillae or around the teeth.
• Generalised: Involving all the gingiva throughout the mouth.

Patient Instructions for Plaque Control

• Tooth brushing techniques (manual or electric brushes).
• Use of interdental cleaners (floss or brushes).
• Use of disclosing tablets to highlight plaque deposits for better awareness.
• Importance of regular hygienist/therapist appointments
• Consulting primary care physician if medication is a potential cause.

Factors Impacting Patients with Gingival Overgrowth (DIGO)

• Speech difficulty
• Aesthetic concerns
• Difficulty with eating
• Increased caries
• Increased periodontitis
• Delayed tooth eruption
• Retention of primary teeth
• Diastema
• Mouth breathing
• Xerostomia
• Low self-esteem
• Halitosis
• Poor oral hygiene

Grading of Gingival Overgrowth

• Grade 0: No signs of gingival enlargement.
• Grade 1: Gingival enlargement confined to interdental papillae.
• Grade 2: Gingival enlargement involving the interdental papillae and gingival margins.
• Grade 3: Gingival enlargement covering more than three-quarters of the crown of the tooth.

Medications and Gingival Overgrowth

• Certain medications, such as Calcium Channel Blockers (Amlodipine, Felodipine, Nicardipine) and Anticonvulsants (Phenytoin), can contribute to gingival overgrowth.
• Alternative medications should be considered if the patient has gingival overgrowth due to their current medication. Alternative medication recommendations are provided.

Plaque and Gingival Overgrowth

• Plaque is a mineralized film covering the teeth (can be supra or subgingival).
• Plaque prevents cavities by covering teeth and preventing sugar attacks; this is not a concerning factor in terms of gingival overgrowth.
• Plaque is always an exacerbating factor in terms of oral health.