gingival enlargement causes eshetic disfigurement. this presentation describes the features of gingival enlargement

2. INTRODUCTION
 The treatment is generally based on an understanding of the cause and underlying pathologic changes
of the condition
 Gingival Enlargements are of special concern to the patient and the dentist because they pose the
problems that involve
** PLAQUE CONTROL
** FUNCTION { including mastication, tooth eruption and speech}
** AESTHETICS

3. CHRONIC INFLAMMOTORY ENLARGEMENT
 Chronic Inflammatory Enlargements , which are soft and discolored and which are caused prinicipally
by Edema and Cellular Infiltration
 They are treated by scaling and root planing provided that the size of the enlargement does not
interfere with the complete removal of deposits from the involved tooth surfaces
 Surgical Removal is the treatment of choice when Chronic Inflammatory Gingival Enlargements
include a
** Significant Fibrotic Component that do not undergo shrinkage
after scaling and root planing

5. 2 techniques are available for this purpose :
{1} GINGIVOPLASTY / GINGIVECTOMY
Gingivoplasty means
Excision of the Gingiva

6. {2} FLAP OPERATION

7. >> The Selection of the appropriate Technique depends on the Size of the Enlargement and the
Character of the Tissue
>> When the enlarged gingiva remains soft and friable even after scaling and root planing , a
Gingivectomy is used to remove its because a flap requires a firmer tissue
>> If the Gingivectomy incision removes all the attached gingiva , thereby creating a mucogingival
problem , then a Flap Operation is indicated
>> Tumor like Inflammatory Enlargements are treated by Gingivectomy

8. ABSCESSES

9. GINGIVAL ABSCESSES
 NECROTIZING ULCERATIVE GINGIVITIS
** Treatment consists of :
[1] Alleviation of the acute inflammation by reducing the microbial load and removal of necrotic
tissue
[2] Treatment of chronic disease either underlying the acute involvement or elsewhere in the oral
cavity
[3] Alleviation of generalized symptoms such as fever and malaise
[4] Correction of systemic conditions or factors that contribute to the initiation or the progression
of the gingival changes

11. ACUTE PERICORONTIS
** Treatment consists of:
(1) Gently flushing the area with warm water to remove debris and exudate
(2) Swabbing with antiseptic after elevating the flap gently from the tooth with a scaler
(3) The underlying debris is removed and the area is flushed with warm water
(4) If the gingival flap is swollen and fluctuant , an incision may be necessary to establish drainage
and relieve pressure

13. ACUTE HERPETIC GINGIVOSTOMATITIS
** Treatment consists of Early Diagnosis and Immediate Initiation of Antiviral
Therapy

14. PERIODONTAL ABSCESS
 ACUTE ABSCESS --- Drainage through pocket retraction (or) incision
 CHRONIC ABSCESS --- Scaling and Root planing (or) Surgical therapy
 Other treatment options:
** Systemic Antibiotics
** Tooth Removal

16. DRUGASSOCIATEDGINGIVALENLARGEMENT
 Gingival Enlargement has been primarily associated with the administration of 3
types of drugs:
{1} ANTICONVULSANTS
{2} CALCIUM CHANNEL BLOCKERS
{3} IMMUNOSUPPRESANTS

17. ANTICONVULSANTS

19. IMMUNOSUPPRESANTS

21. >> Simple Discontinuation of the offending drug is usually not practicable
The following alternatives may be considered:
• Phenytoin Sodium may be replaced by Valproic Acid and Carbamazepine
• Nifedipine may be replaced by Dilitiazem or Verapamil or other groups of Anti hypertensives
like beta blockers , ACE Inhibitors
• Cyclosporine can be substituted by Tacrolimus
>> The replacement drugs also have shown to cause Gingival Overgrowth

25. GINGIVAL ENLARGEMENT DURING PREGNANCY
 Treatment requires the elimination of all local irritants that may be responsible for precipitating
the gingival changes that occur during pregnancy
 Marginal and Interdental Gingival Inflammation and Enlargement are treated by Scaling and
Curettage
 The Treatment of Tumor like Gingival Enlargement consists of Surgical Excision as well as Scaling
and Root Planing of the tooth surface
 The Enlargement recurs unless all irritants are removed and the Food Impaction is frequently an
Inciting factor

26. NEOPLASTIC GINGIVAL
ENLARGEMENTS[Gingival Tumors] and
Other SOLITARY OVERGROWTHS
 Lesions such as : PERIPHERAL GIANT CELL GRANULOMA
: FIBROMA
: PYOGENIC GRANULOMA etc;
Such lesions has to be excised and subjected to histopathological
examination to confirm the clinical diagnosis

28. RECURRENCE OF GINGIVAL
ENLARGEMENT
 After treatment recurrence is the most common problem in management of Gingival
Enlargement
 Responsible factors that cause Non Inflammatory Gingival Hyperplasia are:
** Residual Local Irritation
** Systemic Conditions
** Hereditary Conditions
 Recurrence of Chronic Inflammatory Enlargement immediately after treatment indicates that
all irritants have not been removed

29. >> If the enlargement recurs after healing is complete and normal contour is attained
, inadequate plaque control by the patient is the most common cause
>> Recurrence during the healing period is manifested as red, bead like,
granulomatous masses that bleed with slight provocation
>> Healing tissues are highly sensitive to plaque buildup and very quickly the gingiva
increases in size
>> Familial , Hereditary or Idiopathic Gingival Enlargement recurs after surgical
removal even if all local irritants are removed
>> Enlargement can be maintained at minimal size by preventing secondary
inflammatory involvement