Management Of Gingival Enlargement

Management Of Gingival Enlargement - A CLINICAL CASE REPORTDepartment Of PeriodontologyUniversity Medical & Dental College, FaisalabadPresented By:Dr. Maliha TahirDr. Humna Najeeb(House Officers)

guided by:dr. uzma khanamDR. qurat ul AIN Gingival enlargement is defined as an overgrowth or increase in the size of gingiva.

Gingival enlargement is usually caused by local conditions such as poor oral hygiene, food impaction, or mouth breathing.

The involved tissues are glossy, smooth, and edematous and bleed readily. Loss of interseptal bone and drifting of the teeth occur in long standing cases of inflammatory enlargement.

Based on the etiological factors and pathological factors: I. Inflammatory enlargement a. acute b. chronicII. Drug induced enlargement a. anticonvulsants (phenytoin, barbital, ethosuximide) b. calcium channel blockers (nifedipine, amlodipine, verapamil) c. cyclosporine, an immunosuppresantIII. Enlargements associated with systemic disease or conditions Conditioned enlargementa. pregnancyb. pubertyc. vitamin C deficiency d. nonspecific, such as a pyogenic granuloma

III. Systemic disease causing enlargementleukemiagranulolomatous diseases

IV. Neoplastic enlargement benign neoplasms, such as fibromas, papillomas and giant cell granulomasmalignant neoplasms, such as a carcinoma or malignant melanoma

V. False enlargement

Degree of enlargementGrade 0: No signs of gingival enlargement

Grade I: confined to interdental papilla

Grade II: involve papilla and marginal gingiva

Grade III: enlargement covers three quarters or more of the crownManagement Management of gingival hyperplasia depends on the cause of the condition. In general, reinforcement of good home care oral hygiene regimens and periodic professional surgical excision of gingiva are the treatments of choice.Management

CASE REPORT A 26 year old lady came with a complaint of painless gingival overgrowth in the anterior upper and lower arch.

Patient had gingivectomy 8 years ago but the condition recurred a year after the procedure.

Medical history Systemic history unremarkable Any previous drug history unremarkable Past medical history unremarkable Family history unremarkableClinical examination The extra-oral examination: Did not reveal any abnormality. The intra-oral examination revealed: localised, severe gingival enlargement involving both labial and lingual regions in the maxillary and mandibular arches.InvestigationsRadiograph

Patients report showing normal blood profilelab diagnosis

management Differential Diagnosis:Inflammatory gingival enlargementGingival hyperplasia due to mouth breathingHormone induced gingival enlargementIdiopathic gingival fibromatosis Patient education: Prognosis Oral hygiene instructions Dietary changes Counselling

Treatment plansurgical periodontal(non surgical)

Periodontal (non surgical) procedure: Scaling & deep curettage done under L.A

Surgical procedure:

Gingivectomy

Post-op instructions Saline rinses for a week Avoid hot drinks for 24 hrs Avoid tooth brushing for 24 hrs Enziclor mouthwash for 2 weeks. Augmentin Flagyl SynflxPost-op wound infection prophylaxis:Follow-up visit

Biopsy result has not yet arrived.

The patient is advised to maintain a scrupulous oral hygiene and is kept under regular observation. ReferencesClinical Periodontology Carranza, Takei, Newman. 10th edition.Journal of Clinical PeriodontologyVolume 21 Issue 4 Page 256-259, April1994UNILATERAL GINGIVAL ENLARGEMENT - A CASE REPORT Pravara Med Rev 2010; 2(2)