2. CLASSIFICATION OF
GINGIVAL ENLARGEMENT
O 1. Inflammatory Enlargement
a. chronic
b. acute
2. Drug-induced Enlargement
a. anticonvulsants
b. immunosuppressants
c. calcium channel blockers
3. O 3. Enlargement associated with
systemic diseases or conditions
a.Conditioned enlargement
1)pregnancy
2)puberty
3)vitamin C deficiency
4)plasma cell gingivitis
5)non specific conditioned
enlargement
(pyogenic granuloma)
4. O 4) Neoplastic Enlargement
a. Benign tumors
b. Malignant tumors
5)False Enlargement
5. ON THE BASIS OF
LOCATION AND
DISTRIBUTION
O Localised
O Generalized
O Marginal
O Papillary
O Diffuse
O Discrete
6.
7.
8. DEGREE OF GINGIVAL
ENLARGEMENT
O Grade 0 – No signs of gingival
enlargement
O Grade I -- Enlargement confined to
interdental papilla
Grade II – Enlargement involves papilla
and
marginal gingiva
Grade III – Enlargement covers three
quarters or more of the
crown
14. 3) Etiology
Chronic inflammatory gingivitis is
caused by prolonged exposure to dental
plaque.
Factors that favor plaque accumulation
and retention include
-Poor oral hygiene
- Irritation by anatomic abnormalities
- Improper restorative and orthodontic
appliance
15. Gingival Changes Associated
With Mouth Breathing
O Red and edematous gingiva
O Diffuse surface shininess of the exposed
area
O Maxillary anterior is the commonest site
of involvement
O Harmful effect is generally attributed to
irritation from surface dryness
16. Acute Inflammatory
Enlargement
1) Gingival Abscess
Results from bacteria carried deep
into the tissues when a foreign substance
(eg-toothbrush bristle , lobster shell
fragment ,etc) is forcefully embedded into
the tissue .
2) Periodontal abscess (Lateral abscess)
Localized purulent inflammation in
the periodontal tissues.
18. O Gingival enlargement is a well known
consequence of the administration of
some drugs such as
- anticonlvulsants
- immunosupressants
- calcium channel blockers
19. Clinical features
O Clinical and microscopical features of
enlargement caused by different drugs
are same.
O Starts as painless beadlike enlargement
of interdental papilla . As the condition
progress ,the marginal and papillary
enlargements unite to form massive tissue
fold that covers considerable portion of
the crowns.
20. O When uncomplicated by inflammation ,
the lesion is mulberry shaped , firm ,
pale pink and resilient .
O This enlargement do not have tendency
to bleed
O Enlargement makes plaque control
difficult which leads to secondary
inflammatory process which complicates
the gingival over growth
O More severe in maxillary and mandibular
anterior region
21. O Enlargement is chronic and slowly
increases in size
O Even if surgically removed , It recurs .
22. ANTICONVULSANTS
O The first drug induced gingival
enlargements reported were those
produced by Phenytoin(Dilantin)
O Other hydantoins that induce gingival
enlargement are ethotoin, mephenytoin ,
etc
O Etiology
23.
24. Immunosuppressants
Cyclosporine is potential
immunosuppressive drug which induce
gingival enlargement .
Cyclosporine induced enlargement is
more vascularized than phenytoin
enlargement.
25.
26. Histopathology
O Presence of plasma cells and abundant
amorphous extracellular substance
suggest that enlargement is a
hypersensitivity reaction .
27. Calcium Channel Blockers
O Nifedipine induces gingival enlargement.
O Other drugs are amlodipine , felodipine ,
diltiazem ,etc .
30. OConditioned enlargements
- It occurs when systemic condition
of the patient distorts the gingival response
to dental plaque
- Bacterial plaque is necessary for
initiation of this type of enlargement
There are three types of conditioned
enlargement
1. Hormonal(pregnancy and puberty)
2. Nutritional
3. Allergic
31. Enlargement in pregnancy
O Marginal and generalized
O Hormonal changes induce change in
vascular permeability , which leads to
gingival edema and increased
inflammatory response to dental plaque.
1)Marginal enlargement
Enlarged gingiva is bright red or
magenta , soft and friable .
32. 2) Tumor like gingival enlargement
- The so called pregnancy tumor not a
neoplasm
- It is due to the inflammatory response
of body to dental plaque
- Usually appers after 3rd month of
pregnancy
- lesions appear as a discrete ,
mushroom like , flattened and spherical
mass that protrudes from the gingival
margin
