gingival hypertrophy

Gingival Hypertrophy: An Overview

Gingival hypertrophy, also known as gingival enlargement or overgrowth, refers to the abnormal growth of gum tissue around the teeth. This condition can cause discomfort, interfere with speech and chewing, result in bad breath (halitosis), and affect the appearance of the mouth.

Characteristics of Gingival Hypertrophy

• The gums become enlarged and firm, covering a significant portion of the teeth.
• The condition can be symmetrical or localized, affecting one or more dental quadrants.
• In severe cases, the gums may completely cover the teeth, making it difficult to maintain effective oral hygiene.

Causes of Gingival Hypertrophy

• Inflammatory Gingival Enlargement: This is the most common cause, resulting from poor oral hygiene and gum disease.
• Medication-Induced Gingival Enlargement: Certain medications, such as phenytoin, cyclosporine, and calcium channel blockers, can cause this condition.
• Hereditary Gingival Fibromatosis: A rare genetic disorder that leads to abnormal growth of the gums.
• Systemic Diseases: Conditions like leukemia, diabetes, and certain infections can also contribute to gingival hypertrophy.

Symptoms and Complications

• Discomfort and pain in the mouth
• Difficulty speaking or chewing
• Bad breath (halitosis)
• Aesthetic concerns due to the appearance of the gums

Treatment and Management

• The treatment depends on the underlying cause, but controlling inflammation through proper oral hygiene is essential.
• In some cases, surgical excision of the hypertrophied tissue may be necessary.

References:

[1] Gingival enlargement or gingival overgrowth, a common trait of gingival disease, is characterized by an increase in the size of gingiva. Pertinent management ... (Source: [5]) [2] Gingival hyperplasia refers to an overgrowth of your gums (also known as your gingiva), rather than a specific condition. (Source: [8]) [3] Gingival hypertrophy is characterized by diffuse, relatively avascular smooth or nodular enlargement of the gingiva, which may almost cover some teeth. (Source: [15])

Gingival Hypertrophy Signs and Symptoms

Gingival hypertrophy, also known as gingival hyperplasia, is a condition characterized by the overgrowth of gum tissue around the teeth. This can lead to various signs and symptoms that affect oral health and overall well-being.

Common Symptoms:

• Swollen, red, and painful gums [6][7]
• Difficulties cleaning between teeth due to gum overgrowth [8]
• Tender and bleeding gums [6][9]
• Inflammation and pain in and around the gums [7]
• Bad breath (halitosis) [4]
• Plaque buildup on teeth, leading to further inflammation [7]

Types of Gingival Hypertrophy:

• Localized gingival hypertrophy: Overgrowth of gum tissue on a group of teeth, with confined location [11]
• Generalized gingival hypertrophy: Overgrowth of gum tissue in the entire mouth, affecting multiple teeth [11]

Other Possible Symptoms:

• Pain and discomfort while chewing or speaking
• Difficulty eating or swallowing due to gum overgrowth

It's essential to note that these symptoms can be similar to those experienced with other oral health conditions, such as gum disease (gingivitis and periodontitis). A proper diagnosis by a dental professional is necessary to determine the underlying cause of gingival hypertrophy.

References:

[1] Gingival hyperplasia is an enlargement or overgrowth of the gum tissue. [3] [2] The treatment depends on the underlying cause. [4] [5] Leukemia can cause symptoms that affect the mouth, including gingival enlargement. [6] [7] Gums affected by this condition are often tender, soft, red, and bleed easily. [8] [9] Symptoms and Signs · Tender Gums · Bleeding Gums · Inflammation · Pain and Discomfort In and Around Gums · Infection and Pus Formation · Bad Breath · Plaque Buildup on ... [10] [11] Localised Gingival Hyperplasia – The gum tissue is overgrown on a group of teeth; the location is confined. Generalised Gingival Hyperplasia – The gum tissue in the entire mouth is affected.

To diagnose gingival hypertrophy, your healthcare provider may perform various diagnostic measures and tests. These may include:

• A thorough exam and history to identify possible drug causes, hormonal influences, and other underlying factors [1].
• Collecting your full medical history and asking what medications you currently take [2].
• Performing an oral exam to assess the extent of gingival hypertrophy [3].
• Recommending biopsy of the affected tissue to determine the exact cause of gingival enlargement [4].
• Ordering other tests like a blood panel to rule out systemic disorders or infections [5].

In some cases, further tests such as blood studies or a biopsy may be necessary to determine the exact cause of your gingival enlargement. For example, patients with neurofibromatosis may present with diffuse unilateral gingival enlargement of attached gingivae [6]. A positive family history of gingival enlargement can also aid in diagnosis [7].

Additionally, a peripheral blood smear can show myeloid blasts in many cases, and a bone marrow biopsy is critical to the diagnosis of certain conditions associated with gingival hypertrophy [8].

It's worth noting that differential diagnosis is essential in identifying the underlying cause of gingival hypertrophy. This involves ruling out other conditions that may present similarly, such as inflammation or systemic disorders [9]. A correct diagnosis can prove life-saving for patients where gingival enlargement could be a primary sign of potentially lethal systemic diseases [10].

References: [1] Context 1 [2] Context 2 [3] Context 4 [4] Context 4 [5] Context 8 [6] Context 4 [7] Context 5 [8] Context 8 [9] Context 11 [10] Context 12

Treatment Options for Drug-Induced Gingival Hypertrophy

Gingival hypertrophy, also known as drug-induced gingival overgrowth (DIGO), is a side effect of certain medications that can cause the gum tissue to become enlarged. The most effective treatment approach for this condition is to withdraw or substitute the offending medication.

• Medication Withdrawal/Substitution: Stopping the use of the causative medication or substituting it with an alternative can lead to significant improvement in symptoms (3). This approach may be particularly effective when the patient has been taking the medication for a short period.
• Antibiotics: In some cases, antibiotics such as azithromycin have been used to slow down the progression of gingival overgrowth (7).
• Oral Hygiene Program: Implementing an appropriate oral hygiene program can help control the inflammatory component and limit the severity of the condition (2).

Surgical Management

While medication withdrawal/substitution is often the first line of treatment, surgical management may become necessary when medical treatment is unsuccessful. Surgical options include:

• Gingivectomy: A surgical procedure that involves removing excess gum tissue to restore normal gum contours.
• Laser Gingivectomy: A minimally invasive surgical technique that uses a laser to remove excess gum tissue (12).

Prevention

Preventing drug-induced gingival hypertrophy is crucial, especially for patients taking medications such as phenytoin, cyclosporine, or calcium channel blockers. Adequate plaque control and discontinuing or altering the offending medication can help prevent this condition.

References:

• [3] The most effective treatment of drug-related gingival enlargement is withdrawal or substitution of medication.
• [2] Controlling the inflammatory component through an appropriate oral hygiene program may benefit the patient by limiting the severity of the gingival overgrowth.
• [7] Azithromycin has been used in some cases of drug-induced gingival overgrowth, as this antibiotic can slow down the progression of the condition.
• [12] Inflammatory gingival enlargement, sometimes referred to as gingival hyperplasia or gingival hypertrophy, is an abnormal proliferation of gingival tissues caused by underlying inflammation.

Causes of Gingival Hypertrophy

Gingival hypertrophy, also known as gingival enlargement, refers to the thickening or overgrowth of the gum tissue surrounding the teeth. The differential diagnosis of this condition involves identifying the underlying causes, which can be grouped into four categories:

• Inflammatory Gingival Enlargement: This is the most common cause of gingival hypertrophy, resulting from plaque-induced inflammation and poor oral hygiene.
  • Caused by poor oral hygiene and plaque retention [9]
  • Can be modified by systemic disease or medications [4]
• Medication-Induced Gingival Enlargement: Certain medications, such as calcium channel blockers and cyclosporine, can cause gingival hypertrophy.
  • Calcium channel blockers are associated with gingival hyperplasia [2]
  • Cyclosporine is another medication linked to gingival enlargement [2]
• Genetic Predisposition: Some individuals may be born with a genetic predisposition to develop gingival hypertrophy.
  • Diffuse gingival swellings have many aetiologies, including genetic predisposition [6]
• Other Causes: Other factors, such as hormonal alterations, gastrointestinal disorders, and immune-mediated diseases, can also contribute to gingival hypertrophy.

Clinical Features and Diagnoses

When diagnosing gingival hypertrophy, it is essential to consider the patient's medical history, dental history, and the extent of the enlargement. A thorough evaluation of the type, nature, and extent of the enlargement is necessary to determine the underlying cause.

• Decision tree: Differential diagnosis of gingival enlargement requires thorough dental and medical history, careful evaluation of the type, nature and extent... [3]
• Most commonly, gingival overgrowth is a plaque-induced inflammatory process, which can be modified by systemic disease or medications. [4]

References

[1] AA Agrawal (2015) - Decision tree: Differential diagnosis of gingival enlargement requires thorough dental and medical history, careful evaluation of the type, nature and extent...

[2] The differential diagnosis of gingival hyperplasia includes calcium channel blockers, cyclosporine, familial gingival fibromatosis, gingivitis, leukemia,...

[3] by AA Agrawal · 2015 · Cited by 199 — Decision tree: Differential diagnosis of gingival enlargement requires thorough dental and medical history, careful evaluation of the type, nature and extent...

[4] by J Beaumont · 2017 · Cited by 81 — Most commonly, gingival overgrowth is a plaque-induced inflammatory process, which can be modified by systemic disease or medications.

[5] There are several causes of gingival enlargement and they can be grouped into four categories: 1) inflammatory gingival enlargement, 2) medication-induced...

[6] by J Christoforou · 2024 — Diffuse gingival swellings have many aetiologies including genetic predisposition, hormonal alterations, gastrointestinal disorders, immune-mediated...

[7] by J Beaumont · 2017 · Cited by 81 — This paper aims to discuss clinical features and diagnoses for conditions presenting with gingival overgrowth and other enlargements of gingival tissues.

[8] by E Fisekcioglu — Differential Diagnosis​​ Gingival hyperplasia has been associated with a variety of factors, including medications, inflammation and systemic...

[9] Dec 2, 2021 — Differential Diagnosis. Inflammatory hyperplasia. Gingivitis; Poor oral hygiene and plaque retention; Restorative and Orthodontic Applicances.