clinical management of gingival enlargement

Your Diagnosis Is Not The End But The Beginning Of Practise.

CLINICAL MANAGEMENT OF GINGIVAL

ENLARGEMENT

DR. DEEPA PHILIPSUNDER THE GUIDANCE OF

DR. NYMPHEA PANDITDR. SHALINI GUGNANI, DR. DEEPIKA BALI.

DEPT OF PERIODONTICS, D.A.V DENTAL COLLEGE,YAMUNANAGAR

DEFINITION

Increase in size of the gingiva. Overexuberant response to avariety of local and systemicconditions.

EPULIS•Fibroma

•Pyogenic granuloma•Peripheral giant cell

granuloma•Peripheral ossifying

fibromaMETASTATIC

LESIONS

•DRUG INDUCED HYPERPLASIA

•LEUKEMIC INFILTRATE

•IDIOPATHIC ENLARGEMENT

MAKING A DIFFERENTIAL DIAGNOSIS

SOFT AND EDEMATOUS FIBROUS

SCALING AND

ROOT PLANING

SHRINKAGESURGERY

FLAP SURGERYGINGIVECTOMYMAINTENANCE

• NO CLINICAL ATTACHMENT LOSS• NO BONE LOSS

• ABUNDANT KERATINISED TISSUE

• OSSEOUS DEFECTS • LIMITED KERATINISED

TISSUE

GINGIVECTOMY FLAP SURGERY

MAINTENANCE PHASE

A CASE REPORT• Chief complaint of

swollen gums and bleeding from gums.

• Slow and progressively increasing in size .

• History excluded any epilepsy, physical or mental disorder.

• ON EXAMINATION the enlargement was present on the left side involving maxilla and mandible which did not cross midline.

• The gingiva was pale pink, firm and of fibrous consistency and gave a pebbled appearance.

• It was pink in colour with a tendency to bleed and didn’t extend beyond the MGJ

• Grade III mobility present in relation to # 26 # 27.

INVESTIGATIONS DONE.

• History to exclude drug intake.• Complete blood profile done to

exclude any malignancy.• Histopathology of the excised tissue.

GENERALISED DIFFUSE IDIOPATHIC

ENLARGEMENT

IDIOPATHIC ENLARGEMENT

• Etiology not known• Inheritance shows autosomal

dominant trait in many cases.• Begins before the age of 20 and is

correlate with the eruption of decidous and permanent teeth.

• Presence of teeth thought to be the “ INITIATING FACTOR”

SURGICAL EXCISION

AFTER HEALING

Pre operativePre operative Post operative

EXCISED TISSUE

HISTOPATHOLOGY

• Tissue showed dense fibrocollagenous tissue infiltrated with intense acute and chronic inflammatory cells.

• Foci of necrosis and calcification also seen.

• Overlying epithelium showed thin elongated rete pegs extending into the fibrocollagenous tissue.

HISTOPATHOLOGY

LASER GINGIVECTOMY• Remarkable cutting ability.• Generates a coagulated tissue layer.• Greater accuracy in making incisions.• Minimal swelling and scarring.• Haemostasis.• Anticoagulant therapy patients.

ELECTROSURGERY• Produces haemostasis.• Thermal necrosis of surrounding zone due to

production of latent heat.

CONCLUSION

• Gingival enlargement may come to attention as a presenting complaint or an incidental finding.

• Its association with systemic diseases demands a diagnostic work up in a logical step wise approach.

• Cases of chronic inflammatory enlargement can just be treated by exquisite dental hygiene.

• When it is medication related discontinuation or substituition is the gold standard.

• Idiopathic enlargement which persists despite aggressive oral hygiene needs to be considered for surgical reduction.

• THIS SHOULD BE CONSIDERED AS A LAST LINE MEASURE.

Making a correct diagnosis is the first step in treating a case successfully……

THANK YOU……