This case report addresses the diagnosis and treatment of a case of idiopathic gingival enlargement in a yearold female. Gingival enlargement ge is a frequent finding in many gingival and periodontal diseases with or without associated systemic conditions. Gingival bleeding on slight provocation was also appreciated. Management of druginduced gingival enlargement barbara anne taylor, department of periodontics, united dental hospital of sydney, sydney synopsis healthy gums are pale pink or pigmented, and wrap tightly around the neck of the teeth. It occurs as a side effect following the administration of drugs used mainly for nondental treatments and thus, the overgrowth cannot be explained as a variation. Diffuse, fibrotic gingival enlargement with partial coverage of the tooth crowns in a patient. Gingival enlargement may result from the administration of. Gingival hyperplasia for a problem that is so common, there is really not very much in the veterinary literature on this odd condition, so it seems time for me to tell you a bit about my understanding of gingival hyperplasia, what brings it about, why it is a concern and how we manage it. To get the facts on exactly how to eliminate your uterine fibroids from the root 100% naturally and permanently and achieve lasting freedom from pcos related symptoms without spending your hardearned money on drugs and over the counters. Gingival enlargement, chronic myeloid leukemia, zimmermannlaband syndrome.
Learn the shocking truth about uterine fibroids, drugs and surgeries. Gingival enlargement the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. It is an unwanted side effect of certain systemic drugs given for nondental treatment. Extramedullary involvement of leukemia can occur in up to 40% of patients.
Discussion systemic medications are the most common causes of gingival enlargement. Media in category gingival enlargement the following 3 files are in this category, out of 3 total. These are strictly clinical descriptive terms, and they avoid the erroneous pathologic connotations of terms used in the past, such as hypertrophic gingivitis and gingival hyperplasia. Druginduced gingival enlargement gingival enlargement is a well known consequence of administration of drugs such as anticonvulsants immunosuppressants calcium channel blockers clinical features 1. Gingival enlargement as oral manifestation in acute myeloid. This entails thorough examination of the oral mucosa, gingiva, teeth, tongue and. One of the main drugs associated with go is the antiepileptic. In a study, 25 patients were monitored during and after treatment with fixed orthodontic appliances. To come up with proper care and treatment, the root cause of the problem should be established. Systemically related gingival enlargements include, but are not limited to, scurvy, leukemia, puberty, pregnancy, multisystem syndromes and selected drugs andor agents. A case of acute monocytic leukemia in a 25 year old pregnant lady who reported with gingival enlargement is presented here.
Nevertheless, the overgrowth involves the gingival margin with extension to the interdental papilla. Predisposing factors include inflammation, leukemia hormonal disturbances, uncontrolled diabetes and drug use 1. Smartdraw includes s of professional healthcare and anatomy chart templates that you can modify and make your own. It is an undesirable side effect seen in patients on.
Gingiva overgrowth an overview sciencedirect topics. This is most likely the result of the angle sna can be used to evaluate the a fracture in an all ceramic crown may be caused by 1. Gingival enlargement is often associated with calcium channel blockers and ciclosporin. Recently it is known that gingival overgrowth may be a consequence of the administration of three groups of medicaments anticonvulsants 2, calcium channel blockers. Acute monocytic leukemia, acute myeloid leukemia, gingival enlargement, immunophenotyping. Gingival enlargement extended on to onethird to onehalf of the crown portion of teeth. Gingival enlargement an overview sciencedirect topics. Regardl ess of its cause, gingival enlar gement can cause problems in controlling pl aque, chewing, teething, speech and aesthetics 1. Gingival hyperplasia treatment, symptoms, causes, pictures.
Nov 19, 2010 idiopathic gingival enlargement is a proliferative fibrous lesion of the gingival tissue that causes esthetic and functional problems. However due to their varied presentations, the diagnosis of these entities becomes challenging for the clinician. In fact, elements of granulation tissue are frequently observed, as are giant cells, mesenchymal cells combined or not with fibroblasts, collagen. Gingival enlargement induced by felodipine resolves with a. There are many anticonvulsants, immunosuppressants and calcium channel blockers that may lead to gingival enlargement in varied presentations table table1 1 and figure figure7. Druginduced gingival overgrowth or enlargement occurs in whole or in part from systemic drug use. Jun 10, 2014 druginduced gingival enlargement gingival enlargement is a well known consequence of administration of drugs such as anticonvulsants immunosuppressants calcium channel blockers clinical features 1. Contents definition etiology classification clinical picture treatment questions 1262014 2 3. Gingival gum enlargement, also known as gingival hyperplasia or hypertrophy, is an abnormal overgrowth of gingival tissues. Digo is a common clinical problem that often requires intervention. Nonsurgical techniques can limit the occurrence of this unwanted affect, reduce the extent of plaqueinduced gingival inflammation and reduce. Gingival enlargement definition of gingival enlargement. Oral contraceptives induced gingival overgrowth a clinical. Gingival enlargement is a common clinical feature of gingival and periodontal diseases.
The aim of this study was to investigate the role of nickel in orthodontic treatmentinduced gingival hyperplasia. Gingival hyperplasia in acute leukemia stanford medicine. The nickel concentration in gingival tissues with and without overgrowth, histopathology of gingival overgrowths, and epithelial cell proliferation response to different nickel concentrations were analysed. The enlargement can be inflammatory,fibrotic or a combination of both. Gingival enlargement is a well recognized unwanted effect associated mainly with anticonvulsant drugs, immunosuppressant drugs and calcium. Painless, beadlike enlargement of the interdental papilla and extends to facial and lingual gingival margins 2. Gingival enlargements are quite common and may be either inflammatory, non inflammatory or a combination of both. Acute myeloid leukemia aml is a bone marrow cancer, a malignant disease that triggering the cells develops into. Leukemia is a malignancy of white blood cells, which may result in significant morbidity and mortality. There are several causes of gingival enlargement and they can be grouped into four categories.
Aug 12, 2010 in some pathological conditions, gingivitis caused by plaque accumulation can be more severe, with the result of an overgrowth. This condition is also known as gingival overgrowth, hypertrophic gingivitis or gingival hypertrophy. Plaque induced inflammation appears to be a general stimulating effect regardless of the mechanism of gingival enlargement. Prescription of calcium channel blockers is relatively common, making it difficult to determine the true incidence of druginduced gingival enlargement.
In addition, fibrotic gingival enlargement has been reported and is believed to be the result of a genetic predisposition for example hereditary or familial gingival enlargement. Drugs associated with ge can be grouped into anticonvulsant drugs phenytoin 3 5, potent immunosuppressants cyclosporin 6 8, and. Signs and symptoms related to gingival enlargement are seen within 24 mo of initiation of drug intake. Gingival enlargement in leukemia occurs due to infiltration of premature leukocytes. After many caries free years a 78 year old patient develops multiple root surface caries. Inflammatory enlargement was ruled out as the inflammatory component plaque and calculus was not significant to the severity of the presented gingival enlargement.
Feb 21, 2017 the enlargement can be inflammatory,fibrotic or a combination of both. An increase in size of the gingiva is a common feature of gingival disease. Gingival enlargement commonly occurs in patients treated with fixed orthodontic appliances. The clinical presentation of the gingiva was similar to that of hereditary gingival hyperplasia but did not have a contributory medical or family history. Gingival overgrowth go is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressant, and calcium channel blockers. In most cases, the enlargement results because of local irritations. Gingival hyperplasia can be seen in patients with familial gingival enlargement, pregnancy and leukemia. Aug 09, 2016 flap technique for gingival enlargement.
Gingival enlargement, the currently accepted terminology for an increase in the size of the gingiva, is a common feature of gingival disease. Acute myelomonocytic leukemia presenting with gingival enlargement as the only clinical manifestation. It is being reported with three main groups of drugs like calcium channel blockers ccbs, immunosuppressants, and anticonvulsants. On palpation, gingiva was soft, edematous, devoid of stippling and tender on palpation. In some instances, gingival hyperplasia is drug induced or may exist as an isolated abnormality or as part of a. Introduction gingival enlargement is a common feature of gingival disease and may be caused by fibrous overgrowth or gingival inflammation or a combination of two. Cyclosporineinduced gingival enlargement is more vascularized than phenytoin enlargement figures 1610 and 1611. Gingival enlargement is one of the frequent features of gingival diseases. Gingival enlargement ge, also known as gingival overgrowth or hyperplasia, has a multifactorial aetiology including inflammation, neoplastic conditions, systemic disorders, and medications.
Gingival enlargement can be caused by a number of various stimuli. Pdf gingival enlargement and resolution during and after. Wed like to understand how you use our websites in order to improve them. There are several types available, which will be discussed further down but two of the most important ones are the one induced by. Moreover, the histological classification is still unclear, owing to the wide range of possible histological morphotypes 1, 2. A remarkable decrease in the number of living epithelial cells, starting after 24 hours and continuing during the whole experiment, was observed when 10. Unusual clinical presentation of generalised gingival enlargement. In recent years,flap surgery have been used more often to treat gingival enlargement than gingivectomy. Both genetically and pharmacologically induced forms of gingival enlargement exist. Patient revealed that she no longer experienced discomfort while brushing or sensitivity to hot and cold. Patient is advised to come for followup every 3 months for a period of oneyear.
The periodontal flap technique used for the treatment of. Gingival hyperplasia is a rare condition affecting the patient cosmetically and functionally. Gingival hyperplasia in acute leukemia stanford medicine 25. Gingival enlargement is an increase in the size of the gingiva gums. Create healthcare diagrams like this example called gingival enlargement in minutes with smartdraw. The term gingival overgrowth go only provides a topographic description of the lesion but no histological diagnosis.
The accepted current terms for this condition are gingival enlargement and gingival overgrowth. Idiopathic gingival enlargement is a proliferative fibrous lesion of the gingival tissue that causes esthetic and functional problems. This is strictly a clinical description of the condition and avoids the erroneous pathologic connotations of terms used in the past such as hypertrophic gingivitis or gingival hyperplasia. One of the rarest sites of extramedullary involvement is the oral cavity, with only 5% or less of all patients with aml present with gum infiltration. Feb 29, 2016 gingival enlargement ge, also known as gingival overgrowth or hyperplasia, has a multifactorial aetiology including inflammation, neoplastic conditions, systemic disorders, and medications. Gingival enlargement and its treatment authorstream. Gingival hyperplasia is most commonly seen with the aml subtypes acute monocytic leukemia m5 66. Treatment of druginduced gingival enlargement is based on the clinical features. Gingival enlargement resolution by means of nonsurgical. The role of oral lesions as a diagnostic indicator is. Larger areas of gingival enlargement more than 6 teeth or areas where attachment loss and osseous defect are present should be treated by the flap technique, as should any situation in which the gingivectomy may create a mucogingival problem.
Deffinition gingival enlargement refers to excessive growth of the gums, and may also be known as gingival hyperplasia or hypertrophy. Idiopathic gingival hyperplasia has been described in several case reports. General histological findings include normal overlying epithelium, rete pegs extending deep into underlying connective tissues with some areas of hyperplasia. This is a common symptom that aids in the diagnosis of leukemia and warrants dental consultation. Surgical treatment of gingival overgrowth with 10 years of.
There are several types available, which will be discussed further down but two of the most important ones are the one induced by different medication and the one. Gingival hyperplasia is a medical condition in which the gums increase in size. Gingival enlargement, leukemia, oral manifestations. Inhibitorfree enzyme catalyzes the cleavage of collagen fibrils and soluble. Treatment of gingival enlargement by dr harshavardhan patwal. The lesion may involve the interproximal spaces, and become so extensive that the teeth are displaced and their crowns covered. Go is characterized by the accumulation of extracellular matrix in gingival connective tissues, particularly collagenous components, with varying degrees of inflammation. Gingival enlargement is an unwanted adverse effect of.
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