Your Diagnosis Is Not The End But The Beginning Of Practise.

CLINICAL MANAGEMENT OF GINGIVAL ENLARGEMENT

DR. DEEPA PHILIPS UNDER THE GUIDANCE OF DR. NYMPHEA PANDIT DR. SHALINI GUGNANI, DR. DEEPIKA BALI. DEPT OF PERIODONTICS, D.A.V DENTAL COLLEGE, YAMUNANAGAR

DEFINITION

Increase in size of the gingiva. Overexuberant response to a variety of local and systemic conditions.

INFLAMMATORY ENLARGEMENT DRUG INDUCED

ASSOCIATED WITH SYSTEMIC DISEASES /CONDITIONS

CHRONIC ACUTE
CYCLOSPORINE ANTIHYPERTENSIVES ANTICONVULSANTS

CONDITIONED ENLARGEMENT SYSTEMIC DISEASES BENIGN MALIGNANT

NEOPLASTIC ENLARGEMENTS

FALSE ENLARGEMENTS

LOCALISED GENERALISED

MARGINAL PAPILLARY DIFFUSE DISCRETE

EPULIS Fibroma Pyogenic granuloma Peripheral giant cell granuloma Peripheral ossifying fibroma METASTATIC LESIONS

DRUG INDUCED HYPERPLASIA LEUKEMIC INFILTRATE IDIOPATHIC ENLARGEMENT

MAKING A DIFFERENTIAL DIAGNOSIS A good clinical history

Surgical intervention

SOFT AND EDEMATOUS

FI

OUS

SCALING AND ROOT PLANING

SURGERY SHRINKAGE

MAINTENANCE

GINGIVECTOMY

FLAP SURGERY

DISCONTINUATION/CHANGE OF MEDICATION

ENLARGEMENT REGRESSES

ENLARGEMENT PERSISTS

ORAL HYGIENE RE INFORCEMENT RECALL

PERIODONTAL SURGERY

PERIODONTAL SURGERY

SMALL AREAS OF ENLARGEMENT

LARGE AREAS OF ENLARGEMENT

OSSEOUS DEFECTS LIMITED KERATINISED TISSUE

NO CLINICAL ATTACHMENT LOSS NO BONE LOSS ABUNDANT KERATINISED TISSUE

GINGIVECTOMY

FLAP SURGERY

MAINTENANCE PHASE

A CASE REPORT
Chief complaint of swollen gums and bleeding from gums. Slow and progressively increasing in size . History excluded any epilepsy, physical or mental disorder.

 ON EXAMINATION the enlargement was present on the left side involving maxilla and mandible which did not cross midline. The gingiva was pale pink, firm and of fibrous consistency and gave a pebbled appearance. It was pink in colour with a tendency to bleed and didnt extend beyond the MGJ Grade III mobility present in relation to # 26 # 27.

INVESTIGATIONS DONE.
History to exclude drug intake. Complete blood profile done to exclude any malignancy. Histopathology of the excised tissue.

GENERALISED DIFFUSE IDIOPATHIC ENLARGEMENT

IDIOPATHIC ENLARGEMENT
Etiology not known Inheritance shows autosomal dominant trait in many cases. Begins before the age of 20 and is correlate with the eruption of decidous and permanent teeth. Presence of teeth thought to be the INITIATING FACTOR

SURGICAL EXCISION

AFTER HEALING

Pre operative

Post operative

EXCISED TISSUE

HISTOPATHOLOGY
Tissue showed dense fibrocollagenous tissue infiltrated with intense acute and chronic inflammatory cells. Foci of necrosis and calcification also seen. Overlying epithelium showed thin elongated rete pegs extending into the fibrocollagenous tissue.

HISTOPATHOLOGY

LASER GINGIVECTOMY
Remarkable cutting ability. Generates a coagulated tissue layer. Greater accuracy in making incisions. Minimal swelling and scarring. Haemostasis. Anticoagulant therapy patients.

ELECTROSURGERY
Produces haemostasis. Thermal necrosis of surrounding zone due to production of latent heat.

CONCLUSION
Gingival enlargement may come to attention as a presenting complaint or an incidental finding. Its association with systemic diseases demands a diagnostic work up in a logical step wise approach. Cases of chronic inflammatory enlargement can just be treated by exquisite dental hygiene.

 When it is medication related discontinuation or substituition is the gold standard. Idiopathic enlargement which persists despite aggressive oral hygiene needs to be considered for surgical reduction. THIS SHOULD BE CONSIDERED AS A LAST LINE MEASURE.

Making a correct diagnosis is the first step in treating a case successfully

THANK YOU