[A woman with gingival enlargement]. / Een vrouw met gezwollen tandvlees.

A 65-year-old female complained of diffuse and rapidly progressive gingival enlargement. Gingival overgrowth can be caused by medication, infections or systemic diseases. In case of generalized, quickly progressive gingival enlargement, acute myeloid leukemia should be considered. Blood results showed an acute myelomonocytic leukemia. Treating the leukemia resolved the symptoms.

Overgrowth of soft tissues after transplantation of a connective tissue graft for the treatment of gingival recession.

The application of free connective tissue graft (CTG) is the gold standard in the treatment of gingival recession in the area of teeth and implants. The aim of this case report is to demonstrate a possible mucosal overgrowth complication in the soft tissue grafting area. A 24-year-old patient underwent the treatment of gingival recession in the tooth 2.3 region by an envelope technique using a free CTG from the hard palate region. Seven years after the surgery, a mucosal overgrowth was observed, which developed asymptomatically and did not cause any problems to the patient.

Relationship between periodontal inflammation and calcium channel blockers induced gingival overgrowth-a cross-sectional study in a Japanese population.

OBJECTIVES: Periodontal inflammation is regarded as a risk factor for drug-induced gingival overgrowth (DIGO). In order to elucidate the involvement of periodontal inflammation in DIGO, the periodontal status of subjects who do not develop DIGO despite receiving causative drugs (non-responders) needs to be examined. Therefore, the aim of the present study which was a pilot study was to assess periodontal inflammatory variables in responders (calcium channel blocker induced-GO patients), non-responders, and patients who did not receive causative drugs (non-consumers). MATERIALS AND METHODS: The following parameters were measured: (1) existence of gingival overgrowth, (2) number of teeth, (3) mean periodontal pocket depth (PPD), and (4) percentage of positive sites for bleeding on probing (BOP). The periodontal inflamed surface area (PISA) and periodontal epithelial surface area (PESA) and the PISA/PESA ratio which indicated the degree of periodontal inflammation in each patient were also used to evaluate periodontal inflammation. RESULTS: Thirteen responders, 32 non-responders, and 83 non-consumers were included in the analyses. The mean PPD, percentage of BOP, PESA, and PISA, and the PISA/PESA ratio were significantly higher in responders than in non-responders and non-consumers (p < 0.01). The BOP, PISA, and PISA/PESA ratio were significantly lower in non-responders than in non-consumers (p < 0.05). A positive correlation was found between PPD and age in non-consumers. On the other hand, a negative correlation was noted between PPD and age in non-responders. CONCLUSIONS: Periodontal inflammation may be associated with the initiation of DIGO. CLINICAL RELEVANCE: It could be speculated that periodontal therapy before the administration of calcium channel blockers may prevent the development of gingival overgrowth.

Gingival Enlargement Caused by Vitamin C Deficiency (Scurvy) in a Boy.

Localized gingival enlargement associated with vitamin C deficiency (scurvy) is rarely encountered in the modern era. The purpose of this paper is to report a case of extensive inflammatory gingival enlargement in the mandibular anterior region associated with vitamin C deficiency in a 10 year-old boy. There was a significant improvement of the gingival enlargement seven days after starting oral vitamin C supplementation. Vitamin C deficiency should be included in the differential diagnosis of any gingival enlargement, especially in children.

Harmful consequences of specific substances on the oral health.

Numerous substances may have an adverse influence on the oral region by virtue of their potentially harmful effects. Dental practitioners are often the first to see these effects in the head and neck region. Knowledge of the damaging consequences of agents such as alcohol, tobacco, areca nut, medications, alcohol-containing mouthwashes, dental devices and materials can assist the practitioners in clinical decision-making and accurate diagnosis of associated lesions. More importantly, timely diagnosis and prompt reporting of such harmful effects improve the quality of care. Such knowledge may also help in patient's education for the avoidance of associated adverse effects (AEs). Consequently, a thorough acquaintance of AEs will consolidate the distinct role of medical and oral health practitioners in safeguarding the patients' oral and systemic well-being. This article was planned to review the harmful consequences of specific substances on the oral health. Traditionally, the emphasis of review articles has been on reviewing the harmful effects of a single entity on oral health. This review is unique in the sense that it comprehensively and collectively focussed on the harmful effects on the oral health of addictive and illicit substances (alcohol, betel nut), medications, alcohol-containing mouthwashes, medications and dental materials.

Oral health of pediatric liver transplant recipients.

To evaluate oral health conditions in pediatric liver transplant recipients, with special focus on caries, green staining of the teeth, gingival bleeding, and gingival overgrowth. 40 patients (mean age 11.6 years) were examined at a routine follow-up visit, 6 months to 16 years after liver transplantation at the Swiss Center for Liver Disease in Children. After the medical examination, participants were further examined for the presence of dental caries, periodontal disease, GE, and GTC. The mean decay, missing, and filled teeth (dmft/DMFT) score was 3.8. 45% of the participants presented at least one carious lesion. Two-third of the participants had more than 20% of sites with the presence of plaque and gingival inflammation. Signs of GE were found in 18% and GTC in 30% of the participants. A positive correlation was identified between GTC and peak serum bilirubin (P<.001) and primary diagnosis of cholestatic disease (P=.04). Gingival inflammation was associated with plaque (P<.001), use of immunosuppressive medication (P=.04), and was more pronounced in children with cholestatic disease (P=.007). Children and young adults with liver transplants presented a rather poor oral health status. Liver transplant physicians should counsel patients for regular dental follow-up in order to avoid serious dental infections.

Gingival tissue proliferation into the tooth following iatrogenic miniscrew insertion: A newer underreported complication.

Miniscrew implant (MSI) has been reported to be an excellent, supportive orthodontic anchorage tool. The placement of MSI is not free from complication and foremost of which is penetration of MSI into the vital tooth structures. This case report is probably the first to report a newer underreported complication. Interestingly, a small bit of gingival tissue was found deep inside the dentin of the tooth, surviving and proliferating in the MSI-damaged zone. This case report is probably the first to give direct histological evidence in humans that a MSI can cause implantation phenomenon which has the potential to give rise to numerous pathologies including pulpal, periodontal, and cystic transformation. Through this report, it is emphasized that clinicians should have a structured, formal MSI placement training to avoid such instances and also underlines the need to develop protocols to be followed in the instance of an inadvertent MSI penetration.

Gingival overgrowth: Part 2: management strategies.

The effective and predictable management of gingival overgrowth requires correct diagnosis and consideration of aetiological factors, as discussed in Part 1 (BDJ 2017; 222: 85-91). Initial management should involve cause-related therapy, which may resolve or reduce the lesion. If functional, aesthetic and maintenance complications persist following this phase; further treatment may be required in the form of surgery. This paper discusses management strategies, including management of aetiological factors and surgical techniques.

Gingival overgrowth: Part 1: aetiology and clinical diagnosis.

Most commonly, gingival overgrowth is a plaque-induced inflammatory process, which can be modified by systemic disease or medications. However, rare genetic conditions can result in gingival overgrowth with non-plaque-induced aetiology. It is also important to appreciate the potential differential diagnoses of other presentations of enlarged gingival tissues; some may be secondary to localised trauma or non-plaque-induced inflammation and, albeit rarely, others may be manifestations of more sinister diseases or lesions. A definitive diagnosis will then enable an appropriate management strategy. This paper aims to discuss clinical features and diagnoses for conditions presenting with gingival overgrowth and other enlargements of gingival tissues.

Local cause of gingival overgrowth. Clinical and histological study.

The overgrowth, depending on its extension, has multiple effects on the stomatognathic apparatus: functional disorders (impaired speech), difficulty in chewing and aesthetic problems but can cause significant psychological problems. We proposed this study, motivated by the relative increased frequency of the gum outgrowth, its multifactorial etiopathogeny, but especially from the point of view of the specialist practitioner, by the problems that this pathology raises not only for the functionality of the stomatognathic apparatus but also for the facial esthetics, and especially for future therapeutic attitudes needed to solve the existing pathology at this level. We conducted a clinical study and a histological one. For the clinical study, we selected 74 patients who experienced different degrees of gingival outgrowing associated with fillings, dental caries, fixed prostheses, mobile prostheses, orthodontic apparatus. Thirty gingival fragments from patients with gingival outgrowing were processed by paraffin-embedding histological technique and stained with Hematoxylin-Eosin. The morphological results obtained provide the necessary support for understanding the possibility of developing a therapeutic strategy to prevent or minimize the gum outgrowth by administering antibiotic and anti-inflammatory medications associated with medications, which shall cause the apoptosis of the fibroblasts.

An update on crown lengthening. Part 1: Gingival tissue excess.

This is the first article in a two-part series which aims to provide an overview of the different techniques used to increase clinical crown height. In the first paper, the focus will be on the management of patients who present with gingival tissue excess. The different aetiologies are discussed and illustrated with clinical cases, following which a range of procedures that may be employed in the management of these patients are presented. With an increasingly ageing population, more patients are taking regular medications prescribed from their general medical practitioner, and so having a working knowledge of the specific drugs that may cause gingival enlargement is essential. Clinical Relevance: When patients with gingival tissue excess present in primary or secondary care, a clinician must have a good knowledge of the possible causes of the condition, as well as an idea of how the patient may be managed.

Successful nonsurgical management of post-orthodontic gingival enlargement with intensive cause-related periodontal therapy.

Successful nonsurgical management of severe postorthodontic gingival enlargement and erythema in a 24-year-old male is presented. The patient received an intensive cause-related periodontal therapy, consisting of oral hygiene instruction, scaling and root planing, and weekly recall visits. At week five, complete resolution of the lesions was achieved. By targeting the primary etiologic factor, i.e., plaque, periodontal health was restored without needing surgical intervention. Reducing the bacterial load will give the biologic natural healing capacity of the body the opportunity to stabilize the periodontal condition and, thus, should be considered as the first line of intervention before a surgical approach is taken.

Gingival overgrowth as secondary effect of calcium channel blockers administration. A case report.

Gingival overgrowth is, among other things, a side effect of the administration of dihydropyridine antihypertensives, generally associated with irritant factors of marginal periodontium. This case refers to a patient, female, who developed a large gingival enlargement that has a combined etiology: the systemic medication with lercanidipina and the presence of dental bridges, which are incorrectly adjusted to the dental cervix. The treatment for this case, involved a complex local treatment (antimicrobial, surgical, endodontic and prosthetic) and the collaboration with a specialist cardiologist. Maintaining the normal gingival parameters in time depends on the possibility of changing the antihypertensive medication, the accuracy of the new dental bridges and the periodic monitoring of the patient.

Association between gingivitis and anterior gingival enlargement in subjects undergoing fixed orthodontic treatment.

OBJECTIVE: The aim of this study was to investigate the association among gingival enlargement (GE), periodontal conditions and socio-demographic characteristics in subjects undergoing fixed orthodontic treatment. METHODS: A sample of 330 patients undergoing fixed orthodontic treatment for at least 6 months were examined by a single calibrated examiner for plaque and gingival indexes, probing pocket depth, clinical attachment loss and gingival enlargement. Socio-economic background, orthodontic treatment duration and use of dental floss were assessed by oral interviews. Associations were assessed by means of unadjusted and adjusted Poisson's regression models. RESULTS: The presence of gingival bleeding (RR 1.01; 95% CI 1.00-1.01) and excess resin around brackets (RR 1.02; 95% CI 1.02-1.03) were associated with an increase in GE. No associations were found between socio-demographic characteristics and GE. CONCLUSION: Proximal anterior gingival bleeding and excess resin around brackets are associated with higher levels of anterior gingival enlargement in subjects under orthodontic treatment.

Association between gingivitis and anterior gingival enlargement in subjects undergoing fixed orthodontic treatment

OBJECTIVE: The aim of this study was to investigate the association among gingival enlargement (GE), periodontal conditions and socio-demographic characteristics in subjects undergoing fixed orthodontic treatment. METHODS: A sample of 330 patients undergoing fixed orthodontic treatment for at least 6 months were examined by a single calibrated examiner for plaque and gingival indexes, probing pocket depth, clinical attachment loss and gingival enlargement. Socio-economic background, orthodontic treatment duration and use of dental floss were assessed by oral interviews. Associations were assessed by means of unadjusted and adjusted Poisson's regression models. RESULTS: The presence of gingival bleeding (RR 1.01; 95% CI 1.00-1.01) and excess resin around brackets (RR 1.02; 95% CI 1.02-1.03) were associated with an increase in GE. No associations were found between socio-demographic characteristics and GE. CONCLUSION: Proximal anterior gingival bleeding and excess resin around brackets are associated with higher levels of anterior gingival enlargement in subjects under orthodontic treatment. .

OBJETIVO: o objetivo desse estudo foi verificar a associação entre volume gengival (AG) com condições periodontais e características sócio-demográficas em sujeitos com aparelho ortodônticos fixo. MÉTODOS: uma amostra, de 330 participantes com aparelho ortodôntico fixo, por pelo menos seis meses, foi examinada, por um único examinador calibrado, para os índices de placa e gengivais, profundidade de sondagem, nível de inserção clínico e aumento de volume gengival. O status socioeconômico, tempo com aparelho ortodôntico fixo e uso de fio dental foram verificados por entrevista oral. A verificação das associações foi realizada por meio de modelos de regressão de Poisson sem ajuste e ajustados. RESULTADOS: a presença de sangramento gengival (RR 1.01; 95% IC 1.00-1.01) e o excesso de resina em torno dos braquetes (RR 1.02; 95% IC 1.02-1.03) foram associadas a um aumento do AG. Não foram encontradas associações entre características sócio-demográficas e AG. CONCLUSÃO: sangramento gengival proximal na região anterior e excesso de resina no entorno dos braquetes estão associados a níveis mais altos de aumento de volume gengival na região anterior em sujeitos com aparelho ortodôntico fixo. .

Expression of nuclear receptors of gingiva in polycystic ovarian syndrome: a preliminary case study.

Oestrogen is mainly responsible for alterations in blood vessels and progesterone stimulates the production of inflammatory mediators. In females, during puberty, ovulation and pregnancy, there is an increase in the production of sex steroid hormones, which results in increased gingival inflammation, characterized by gingival enlargement, increased bleeding and crevicular fluid flow. This article presents a case of a patient who presented with a complaint of gingival swelling and spontaneous bleeding that persisted for more than two months. Her health history documented the recently diagnosed presence of polycystic ovarian syndrome. Clinical examination revealed enlarged painful gingival tissues, which bled when touched. After completion of Phase I therapy, the enlargement did not subside and a biopsy sample was taken. This was compared with another patient who had the same health condition but did not show any gingival enlargement. Testing of tissue samples for oestrogen and progesterone receptors showed the first patient to be positive for oestrogen receptors but negative for progesterone, whereas the control was negative for both. Positive oestrogen receptors suggest that polycystic ovarian syndrome has some effect on the periodontium. The dental consequences of this condition, highly prevalent among young females, are typically ignored. Further studies warrant establishment of a clinical association and future diagnosis.

Non-drug induced gingival enlargement.

Gingival enlargement refers to an increase in the size of the gingival tissue. The etiology varies, and often is multifactorial; however, local and systemic conditions, disease, and idiopathic factors may contribute to gingival enlargement. Tissue consistency can vary from soft and spongy to dense, typically appearing darker in shade compared to the drug-induced gingival enlargement. Treatment modalities usually involve surgical removal of excess tissue, non-surgical debridement, use of chemotherapeutic agents, and/or elimination or mitigation of contributing factors and conditions.

Unusual presentation of localized gingival enlargement associated with a slow-growing odontogenic myxoma.

Unusual presentation of localized gingival enlargement associated with a subjacent tumoural pathology is reported. The patient was a 55-year-old black male, whose chief complaint was a progressive gingival overgrowth for more than ten years, in the buccal area of the anterior left mandible. According to the clinical features and the radiological diagnosis of odontogenic keratocyst, a conservative surgery with enucleation and curettage was performed. Tissue submitted for histopathological analysis rendered the diagnosis of odontogenic myxoma. After 12-month of follow-up, no evidence of recurrence was found. Clinicians should be cautious when facing any gingival enlargement to avoid diagnostic pitfalls and to indicate the appropriate treatment.