Gingival enlargement, also called gingival hyperplasia, is thickening or overgrowth of the gum tissues that surround the tooth. This may look like a gingival mass in one area, or it can be generalized and look like knobby gingival growths around each tooth. Dental scaling, root planning, periodontal surgery or gingivectomy that is removal of excess gingival tissue is. Know the causes, symptoms, treatment, classification and epidemiology of gingival enlargement. Treatment planning becomes more complex where there is periodontitis plus gingival enlargement that is a cosmetic or. There are many anticonvulsants, immunosuppressants and calcium channel blockers that may lead to gingival enlargement in varied presentations table table1 1 and figure figure7. Conclusion the treatment of gingival enlargement depends on the type of clinical enlargement encountered. Phenytoininduced gingival overgrowth pigo is a common complication of the. Periodontal management of cyclosporin ainduced gingival. The accepted current terms for this condition are gingival enlargement and gingival overgrowth. Further, indepth studies are needed to establish the link between drugs and gingival enlargement for prevention and improved treatment.
Because of incompatibility between oral soft tissues and prosthesis after treatment of gingival enlargement, renewal of individual dental prosthesis may be needed. Gingival enlargement is one of the frequent features of gingival diseases. Excessive gingival display upon smile is usually considered esthetically displeasing. The treatment of gingival enlargement is based on an understanding of the cause and underlying pathologic changes of this condition see chapter 16. Clinical report systemic and clinical treatment of. Gingival enlargement is a multifactorial condition characterised by abnormal increase in size of the gingiva. Systemic and clinical treatment of gingival hyperplasia.
Individualized treatment plan for gingival enlargement. Anticonvulsants are drugs that can modify the gingival tissues response to inflammatory processes in the presence of dental plaque, inducing gingival overgrowth. The most effective treatment of drugrelated gingival enlargement is withdrawal or substitution of medication. It usually takes few weeks to resolve the gingival lesions 34,35 but response to this method varies 36. Such increased volume of gingiva may compromise normal oral functions. Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement. Druginduced gingival enlargement was first observed in patients who were taking phenytoin for epilepsy, with approximately 50% having gingival overgrowth. Gingival enlargement is the term used to describe medicationrelated gingival overgrowth or gingival hyperplasia,1 a condition commonly induced by three main. Once the cause is identified, the proper treatment can be administered. What is gingival enlargementcausessymptomstreatment. Neoplastic enlargement gingival enlargement is a common finding in clinical practice and the appropriate treatment depends on. Gingival changes can appear within 3 months of drug administration4. Gingival enlargement or overgrowth is a common disease of gingiva. The aim of the treatment with surgical intervention for gingival enlargement is to eliminate.
Top causes of gingival enlargement and treatment options. Phenytoin is an anticonvulsant which is seen to cause gingival enlargement in human patients with a reported incidence of 50%. Signs and symptoms related to gingival enlargement are seen within 24 mo of initiation of drug intake. Chronic inflammatory enlargement, gingival disease, gingival enlargement. This is the most effective treatment of druginduced gingival enlargement. We analyzed reports of digh from srs databases and calculated the.
Gingival gum enlargement, also known as gingival hyperplasia or hypertrophy, is an abnormal overgrowth of gingival tissues. Gingival hyperplasia can be a recurrent condition despite improvements in oral hygiene, professional treatment, and drug substitutions. This overgrowth of gingiva may be exaggerated in patients with genetic or drugrelated systemic factors e. Recognition and treatment of amlodipine norvasc induced. The periodontal flap technique used for the treatment of. Gingival enlargement resolution by means of nonsurgical.
Gingival enlargement is an increase in the size of the gingiva gums. Prevalence and clinical aspects of druginduced gingival. Gingival enlargement can be induced by three main causes stemming from 1 inflammation, 2 medication, and 3 systemic disease. 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. The onset of gingival overgrowth may occur after the first month of treatment but it usually occurs not earlier than 3 months following the initiation of therapy, with. Surgical treatment of gingival overgrowth with 10 years of followup. Treatment of gums enlargement, treatment of gingival. The surgical treatment is the definitive therapy of the druginduced gingival overgrowth, although the recurrence is frequent even with well.
The causative factors may range from inflammation due to local factors to. The modern word for this disorder is a gingival enlargement or gingival overgrowth. Further investigations are required to develop appropriate management strategies to prevent recurrence of digo. Determining the type of gingival enlargement is essential, because each type has its own set of causes. Unfortunately, not all patients respond to this mode of treatment, especially those with longstanding gingival lesions. The enlargement can be inflammatory,fibrotic or a combination of both.
Treatment of gingival enlargement by dr harshavardhan patwal. Gingival enlargement can be a functional and esthetic disparity so in all patients therapy to control gingival enlargement is essential. One of the recurrent and challenging oral diseases is gingival enlargement which strongly affects the esthetic appearance and has a great impact on most dental treatment. If gingival enlargement isnt treated, it may some aesthetic problems, plaque accumulation, gingival bleeding, and periodontitis. Thus, the aim of this study was to evaluate the incidence of digh using spontaneous reporting system srs databases. There are a number of different dental abscesses, such as the gingival abscess, the periapical abscess, and the tooth or abscessed tooth, which is basically a sac filled with liquid or pus. Mild gingival enlargement may only require local management as improvement in oral hygiene, together with professional cleaning of the teeth, can lead to resolution of inflammation and reduction in gingival enlargement.
Management of cyclosporine and nifedipineinduced gingival. Recently, many herbal medicines have been used to enhance the therapy of gingivitis or periodontitis, out of which are the very effective antioxidants. As the ge is not merely due to increase in number or size of cells but due to inflammatory component as well, the term gingival overgrowth or. Chronic inflammatory gingival enlargement and treatment. Treatment can be in the form of allowing for spontaneous resolution once the etiology is removed, instituting proper dental hygiene, nonsurgical treatment, andor surgical treatment. In such cases, overgrown gums may need to be surgically removed. Further, indepth studies are needed to establish the link between drugs and gingival enlargement for. Gingival enlargement due to the local irritation of tha plaque can be treated with plaque control, scaling, root planing until surgery intervention. Gingival enlargement, also synonymous with the terms gingival hyperplasia or hypertrophy, is defined as an abnormal overgrowth of gingival tissues. Among individuals taking phenytoin, gingival overgrowth. The management of gingival hyperplasia on patient with. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications.
Gingival enlargement the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. Treatment of druginduced gingival overgrowth by fullmouth. Treatment of druginduced gingival overgrowth by full. There are many factors causal or modifying involved in gingival overgrowth.
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. Gingival enlargement an overview sciencedirect topics. Chronic inflammatory gingival enlargement associated with. In this paper, inflammatory gingival enlargement and treatment was presented. This article focuses on periodontal methods that can be used to improve the gingival smile when it is caused by altered passive eruption and. Gingival hyperplasia treatment, symptoms, causes, pictures. Gingival pigmentation cause, treatment and histological. Nonsurgical management of gingival enlargement is usually a treatment of choice in patients with mild to moderate gingival overgrowth. An increase in size of the gingiva is a common feature of gingival disease. Calcium channel blockerinduced gingival enlargement.
Gingival enlargement, chronic myeloid leukemia, zimmermannlaband syndrome, nifedipine introduction gingival enlargement ge is defined as an abnormal overgrowth of gingival tissues. Pdf treatment of gingival enlargement researchgate. Unusual clinical presentation of generalised gingival. Because, when it comes to gingival hyperplasia, the treatment depends on the cause. Thus the effective management of gingival enlargement needs a thorough diagnosis and then its disparate management. Nonsurgical periodontal treatment and prosthetic rehabilitation of a renal transplant patient with gingival enlargement. Druginduced gingival enlargement is a common condition which can be observed in patients taking. Histological section showing enlargement of the gingival epithelium and dense fibrous connective tissue accumulation in lamina. Since gingival overgrowth is a druginduced increase in extracellular matrix proteins, the treatment is based on discontinuing the offending medication if at preop view of the maxilla of a fiveyearold wheaton terrier. Gingival enlargement may also lead to bleeding and foul odour from the oral cavity.
Gingival enlargement gingival enlargement refers to excessive growth of the gums, and may also be known as gingival hyperplasia or hypertrophy. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. Treatment of gingival enlargement pocket dentistry. Gingival enlargement and its treatment authorstream. Treating patients with druginduced gingival overgrowth. Accordingly, treatment of the pigmentation is determined either surgically or chemically. Treatment of gingival overgrowth is based on cause of gums enlargement and underlying pathological change which has occurred.
Larger areas of gingival enlargement more than 6 teeth or areas where attachment loss and osseous defect are present should be treated by the flap technique, as should any situation in which the gingivectomy may create a mucogingival problem. Based on the etiology, this condition can be treated with orthodontics alone or with an interdisciplinary approach including other dental specialists. The prime treatment modalities involve obtaining a detailed medical history and nonsurgical periodontal therapy, followed by surgical excision to retain esthetical. Amlodipine is a commonly prescribed drug with the prevalence of gingival hyperplasia being reported as high as 33. A case of a 19yearold male presenting with maxillary and mandibular chronic inflammatory gingival enlargement associated with prolonged orthodontic therapy is reported here. Nonsurgical treatment of gingival overgrowth induced by. Gingivectomy 00109 abstract gingival enlargement is a common feature in gingival disease. A 23 year old female patient reported with a chief complaint of swelling in the gums of teeth in lower front region. Gingival enlargement chronic gingival inflammation may result in gingival enlargement. Phenytoininduced gingival overgrowth management with. The expression and the severity of this tissuespecific condition are influenced by a variety of factors, mainly drug and periodontal variables. Gingival overgrowth is a major and frequent unwanted effect accompanying the chronic usage of antihypertensive, anticonvulsant, and immunosuppressant drugs. It forms below the gum line and creates a swollen bump or lump on the gum.
Conventional versus laser gingivectomy in the management. The patients medical history is important in determining its cause whether physiological or pathological, but the histopathological examination is conclusive. Usually reduction in gingival overgrowth is noticed where a structurally different calcium channel blocker is. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Cyclosporin is an immunosuppressant which has been reported to cause gingival enlargement in 2580% of patients. Several authors have observed a positive association between an intensive oral hygiene programme, supra and subgingival scaling, and improvement of csa gingival overgrowth2224, while others failed to confirm this 2527. Chronic inflammatory gingival enlargement international. The moment the type has been identified, so will be the causes. Pdf on jul 26, 2019, shruti bhatnagar and others published treatment of gingival enlargement find, read and cite all the research you need on researchgate. Pdf on jul 26, 2019, shruti bhatnagar and others published treatment of gingival enlargement find, read and cite all the research you need on. The rftnthcfm treatment of plaqueinduced gingivitis. Gingival pigmentation though not a major complication, yet it greatly affects the facial appearance.
No clinical signs of gingival enlargement in the gingiva were noted 18 months after the second surgery followed by frequent recall appointments and good oral hygiene. There are several causes of gingival enlargement and they can be grouped into four categories. Pdf gingival enlargement is one of the frequent features of gingival diseases. When this treatment approach is taken, it may take from 1 to 8 weeks for resolution of gingival lesions. The management of druginfluenced gingival enlargement. 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. Periodontal treatment of excessive gingival display.
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