Lecture on Gingival enlargement and recession.

1. Gingival Enlargement and
Recession
Dr. Ashif Iqbal
BDS, DDS (BSMMU)
Associate Prof. & Head
Dept: Oral pathology & periodontology
Update Dental College & Hospital

2. Causes of gingival enlargement:
A. According to etiology and pathology:
1. Inflammatory enlargement:
Chronic:
Chronic marginal gingivitis.
Chronic adult periodontitis.
Chronic gingival enlargement in mouth breather.
Acute:
Acute gingival abscess.
Acute periodontal (lateral) abscess.

3. Chronic marginal gingivitis.

5. Fig: Periodontal abscess

6. 2.Drug induced enlargement:
Anticonvulscent – phenytoin.
Immunosuppressant – cyclosporine A.
Calcium channel blocker – nifedipine.
3.Gingival enlargement associated with systemic
diseaase:
a) Conditioned enlargement.
Pregnancy.
Puberty.
Vitamin C deficiency.
Pyogenic granuloma.
b) Systemic diseases causing gingival enlargement:
Leukemia.
Wegener’s granulomatosis.

7. 2.Drug induced enlargement:

8. 2.Drug induced enlargement:

9. Drug : Cyclosporine induced G. enlargement

10. Histopathology of phenytoin
induced G.enlargement
1. Hyperplassia and
acanthosis of epithelium.
2. Densly collagenous
connective tissue.
3. Retepegs formation

11. Histopathology of Cyclosporine induced
G.enlargement
1.Epithelial hyperplassia.
2. Reteridges formation
3. Abundant vascularization.
4. Increase amount of plasma
cells.
Alternative drugs: Tacrolimus

12. 4. Neoplastic enlargement:
Benign tumours-Papilloma, Fibroma, Lipoma
Malignant tumours-Leukemia, SCC
5. Idiopathic/ Hereditary
Hereditary gingival fibromatosis.
6.False enlargement: Enlargement due to pathology of
underlying structure:
Osteoma-Tori and exostosis.
Fibrous dysplasia.
Paget’s disease etc.

13. B. According to location and distribution
1. Localized:
Gingival abscess
Periodontal abscess
Pyogenic granuloma/ Pregnancy tumour
Neoplastic:
Fibroma, Papilloma , Osteoma
Giant cell granuloma
2. Generalized:
Chronic plaque induced gingivitis
Chronic adult periodontitis.
Drug induced enlargement. etc

16. Pyogenic granuloma

18. Treatment:
1st step:
Oral hygiene maintenance.
Scaling and polishing & Root planing if needed
Possible drug substitution.
• Phenytotin-Carbamazepine, Oxcarbamazepine,
Lamotrigine
• Cyclosporine: Tacrolimus, Mycophenolate mofetil
• Nefidipime: Propanolol, Losartan potassium
2nd stage:
If enlargement persist, Surgical gingivectomy is the
treatment choice

20. Pyogenic granuloma/ Pregnancy
tumour (S/N)
It is not a neoplasm but an inflammatory response to
local irritation and is modified by the patient's condition.
It usually appears after the first trimester but may also
occur earlier.
Clinical features
• The lesion appears as a discrete mushroom-like
flattened
spherical mass that protrude from the interdental papilla
or the gingival margin and is attached by a sessile or
pedunculated base.
• It tends to expand laterally

22. • Color—dusky red or magenta with smooth glistening surface
that frequently exhibits numerous deep red, pinpoint
markings.
• Consistency—semifirm, but may have varying degrees
of softness and friability.
• It is usually painless
Histopathology:
It consist consists of a central mass of connective tissue, the
periphery of which is outlined with stratified squamous
epithelium.
Within the connective tissue numerous engorged capillaries
with leukocyte infiltration.
Epithelium is thick with reteridges

23. Treatment:
1. Meticulous plaque control, scaling and root
planing, Polishing should be the only non-
emergent periodontal procedures performed.
The second trimester is the safest time in which
treatment may be performed.
Medication and radiographs should not be prescribed.
2. surgical excision is required which, if possible,
should be postponed until postpartum.

24. Gingival recession:
Gingival recession is defined as the exposure of the root
surface by an apical shift in the position of the gingiva.

25. Types:

26. Visible /Apparent
Hidden

27. Classification:
Two classification systems are available:
I. According to Sullivan and Atkins—Shallow-narrow,
shallow-wide, deep-narrow and deep-wide.
II. According to PD Miller’s—Class I, Class II, Class III
and Class IV.

29. Miller’s classification:
Class I: Marginal tissue recession that does not extend to the
mucogingival junction. There is no loss of bone or soft tissue in the
interdental area. This can be narrow or wide.
Class II: Marginal tissue recession that extends to or beyond the
mucogingival junction. There is no loss of one or soft tissue in the
interdental area. This can be narrow or wide.
Class III: Marginal tissue recession that extends to or beyond the
mucogingival junction. In addition, there is loss of bone and/or soft
tissue in the interdental area or there is malpositioning of the
tooth.
Class IV: Marginal tissue recession that extends to or beyond the
mucogingival junction with severe loss of bone and soft tissue
interdentally and/or severe malpositioning of the tooth.

33. Etiology of gingival recession:
Plaque induced gingivitis.
Plaque induced periodontitis.
Others:
A) Anatomic factors:
 Tooth malposition.
 Presence of dehiscence & fenestration.
 Gingival ablation from soft tissue like
cheek, lips etc.
 High frenulum attachment.

34. B) Habits:
Faulty tooth brushing or brushing
with hard bristle
Iatrogenic factors:
Orthodontic movement.
Primary trauma from occlusion.
Physiological factors: Aging

39. Clinical significance of gingival recession:
The exposed root surface may be extremely sensitive
and susceptible to caries.
Hyperemia of the pulp may result due to exposed root
surface.
 Interproximal recession creates oral hygiene problems
thereby resulting in plaque accumulation.
Finally it is aesthetically unacceptable.

40. Treatment
1.Elimination of etiological factors
Scaling and root planning
Follow up with proper oral hygiene instruction
2. Periodontal surgery in severe condition
Open flap scaling and root planing:
Gingival repositioning surgery.
Regenerative surgery by tissue grafting, tissue
stimulating protein.
Soft tissue graft by different flap surgery