Increase in size of gingiva is called as gingival
enlargement (Gingival overgrowth).
Carranza’s 11 th edition
According to etiologic factors and pathologic changes-
3. Calcium channel blockers
3.Enlargements associated with systemic diseases or conditions
iii)Vitamin C deficiency
iv)Plasma cell gingivitis
v)Non specific conditioned enlargement(pyogenic
According To Location And Distribution
Degree Of Gingival Enlargement
Grade 0- No signs of gingival enlargement
Grade 1 - Enlargement confined to interdental papilla
Grade 2 - Enlargement involves papilla
and marginal gingiva
Grade 3 - Enlargement covers three quarters or
more of the crown
ACUTE INFLAMMATORY ENLARGEMENT
Ballooning of interdental papilla &
Localized or generalized
Progresses slowly & painlessly
Site- Interdental papilla, marginal &
Localized, painful, rapidly expanding
Lesion becomes fluctuant & pointed with
surface orifice within 24-48 hrs
Site- Limited to marginal gingiva or
Prolonged exposure to dental plaque
Poor oral hygiene
Improper restorative & orthodontic
Bacteria carried deep into tissues with a
foreign substance forcefully embedded into
TYPES OF GINGIVAL INFLAMMATORY ENLARGEMENT
Drug-induced gingival enlargement
Gingival enlargement is a well known consequence of administration of
drugs such as
Calcium channel blockers
1. Painless, beadlike enlargement of the interdental papilla and extends to
facial and lingual gingival margins
2. Maxillary & mandibular anterior regions
3. When uncomplicated by inflammation is mulberry shaped, firm,pale
pink, and resilient , with a minutely lobulated surface and no tendancy
4. Project from beneath the gingival margin
SYSTEMIC USE Treatment of all
forms of epilepsy
except petit mal
rejection & several
conditions such as
angina pectoris &
Phenytoin Cyclosporine Nifedipine
Pathogenesis Phenytoin stimulates
fibroblasts like cells
as a hypersensetivity
in 50% of patients
enlargement in 25%-
in 20% of patients
DRUGS ANTICONVULSANTS IMMUNOSPRESSANTS Ca CH.BLOCKER
IDIOPATHIC GINGIVAL ENLARGEMENT
Rare condition of undetermined cause.
-Affects the attached gingiva as well as the gingival margin and interdental
-Involment is limited to the either jaw
-Enlarged gingiva is pink, firm and almost leathery in consistency
-Characterstic minutely pebbled surface
ENLARGEMENTS ASSOCIATED WITH
Systemic diseases and conditions can affect the periodontium by two
1. Magnification of an existing inflammation initiated by dental
2. Manifestation of the systemic disease independently of the
inflammatory status of the gingiva.
HORMONAL Vit.C DEFICIENCY ALLERGIC
3. Bright red or magenta
4. Soft and friable & has
smooth & shiny surface
5. Bleeds spontaneously
2. Bluish red
3. Soft & friable & smooth
& shiny surface
4. Spontaneous bleeding
5. Surface necrosis with
1. Frequent in women &
2. Located on oral aspect
of attached gingiva &
therefore differs from
Female are affected more than male
Common age of occurrence is 11-40 yrs
Its size ranges from 0.9- 2 cm.
Asymptomatic, may be papular or nodular Polypoid mass.
It may become mature and becomes less vascular and more collagenous gradually
converting into a fibrous epulis.
NON SPECIFIC CONDITIONED ENLARGEMENT
Lesions are elevated pedunculated or sessile
masses with smooth lobulated or even warty.
Surface is commonly ulcerated and shows
tendency to hemorrhage upon slightest pressure or trauma.
Variegated red and white pattern.
SYSTEMIC DISEASES CAUSING GINGIVAL ENLARGEMENT
1. Leukemic enlargement may be diffuse or
marginal localized or generalized.
2. The gingiva becomes soft, edematous and
3. Appearance of gingiva is purplish and glossy.
4. There is also pallor in the surrounding mucosa.
5. Ulceration pain and severe hemorrhage can also
6. It has a spongy consistency and bleeds
1. It involve the orofacial region and include oral
mucosal ulceration, gingival enlargement,
abnormal tooth mobility, exfoliation of teeth,
and delayed healing response.
2. “Strawberry gums” appearance of the
mandibular gingiva is commonly seen.
3. Enlargement is reddish purple and bleeds easily
on stimulation but the condition is considered an
1. Common in 5th and 6th decade of life.
2. Carcinoma of mandibular gingiva is more
3. The fixed gingiva is invaded more than the free
4. It usually occurs in premolar area.
5. Quickly spreads from gingiva to alveolar bone
1. Malignant melanoma is a rare oral tumor that
tends to occur in the hard palate and maxillary
gingiva of older persons.
2. It is usually darkly pigmented and is often
preceded by localized pigmentation.
3. It may be flat or nodular and is characterized by
rapid growth and early metastasis.
4. It arises from melanoblasts in the gingiva,
cheek, or palate.
CARCINOMA MALIGNANT MELANOMA
UNDERLYING OSSEOUS LESION
1. Enlargement of the bone subjacent to the
gingival area occur most often in tori and
2. It can also occur in paget’s disease,
fibrous dysplasia, cherubism, central
giant cell granuloma, ameloblastoma,
osteoma and osteosarcoma.
UNDERLYING DENTAL TISSUES
During various stages of eruption
particularly of the primary dentition, the
labial gingiva may show a bulbous
marginal distortion caused by
superimposition of the bulk of the
gingiva on the normal prominence of the
enamel in the gingival half of the crown.
• Root planning
• Oral hygiene
• GingivectomyPHASE II
• Pockets are explored & marked with pocket
• External bevel incision- 45˚ to tooth surface
• Curette granulation tissue
• Surgical pack
• Pockets marked with a pocket marker
• Enlarged tissue removed using needle
• Diode laser and Nd:YAG LASERS
• They have wavelength of 890 nm and
Methods of external bevel gingivectomy
• 5% formaldehyde or potassium
hydroxide can be usedChemosurgery