ISSN 2398-2950      

Gingival enlargement

ffelis
Contributor(s):

Alexander M Reiter

Synonym(s): Hyperplastic gingivitis; Gingival hyperplasia; Epulis


Introduction

  • Gingival enlargment is a clinical term, referring to an increase in the size or thickness of gingiva. Determining a benign or malignant underlying cause for gingival enlargement requires biopsy and histopathological examination of sampled tissues.
  • Epulis is a non-specific term referring to a local, exophytic growth on the gingiva; it should not be used without the addition of adjectives that give the epulis a distictive pathologic entity. 
  • Gingival hyperplasia is a histological (not clinical) term, referring to an abnormal increase in the number of normal cells in a normal arrangement.
  • Gingivectomy and gingivoplasty Gingivectomy and gingivoplasty are surgical procedures designed to remove excess gingiva and to restore its physiological contours.

Pathogenesis

Etiology

  • Hereditary predisposition (familial tendency) for generalized gingival enlargement in brachycephalic breeds.
  • Acute or chronic inflammatory reaction of the gingiva:
  • Drug-induced gingival hyperplasia:
    • Anticonvulsants.
    • Cyclosporine Ciclosporin  Gingiva: hyperplasia (cyclosporine-induced) .
    • Calcium channel blockers.
  • Gingival enlargment due to systemic conditions, causing increased vascular permeability, gingival edema, and increased inflammatory response to dental plaque:
    • Hormonal conditions (eg during pregnancy and puberty in humans; during adolescence and young age in cats: acromegaly Acromegaly).
    • Nutritional disease (eg vitamin C deficiency in humans).
    • Systemic diseases (eg leukemia and granulomatous diseases in humans and dogs).
  • Benign tumors or tumor-like lesions of the gingiva Mouth: neoplasia.
  • Malignant tumors of gingiva Mouth: squamous cell carcinoma.
  • False gingival enlargement, resulting from an increase in the size of the underlying osseous or dental tissues.

Pathophysiology

  • In the case of inflammatory reaction of the gingiva:
    • Plaque accumulation on teeth   →   inflammatory reaction of gingivae   →    gingival enlargement   →    pseudopockets formation   →   further debris and plaque accumulation in pseudopocket    →   continued gingivitis   →    change from aerobic gram-positive to anaerobic gram-negative bacterial flora    →   periodontal attachment loss   →     periodontitis Periodontal disease.
  • In the case of conditioned gingival enlargement (hormonal changes, vitamin D deficiency, etc):
    • Systemic condition   →    increased vascular permeability   →    gingival edema   →    increased inflammatory response of gingiva to dental plaque   →    continuing as above.
  • In the case of drug-induced gingival hyperplasia (independent of local inflammation):
    • Drug administration   →    alteration of gingival tissue, including:
      • Stimulation of connective tissue and epithelial cell proliferation.
      • Prevention of apoptosis (programmed cell death).
      • Upregulation of inflammatory cytokines. 

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Lewis J R, Reiter A M (2005) Management of generalized gingival enlargement in a dog - Case report and review of the literature. J Vet Dent 22 (3), 160-169 PubMed.

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