ISSN 2398-2969      

Gingival enlargement

icanis
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 distinctive 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 dogs.
  • Acute or chronic inflammatory reaction of the gingiva:
    • Acute: gingivitis, periodontal abscess, inflammatory tooth resorption.
    • Chronic: prolonged exposure to dental plaque; mouth breathing in humans with open bite.
  • Drug-induced gingival hyperplasia:
    • Anticonvulsants.
    • Cyclosporine Ciclosporin Gingiva: hyperplasia 01 (cyclosporine-induced) Gingiva: hyperplasia 02 (amlodipine-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).
    • 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 Non neoplastic oral masses.
  • Malignant tumors of gingiva Mouth: squamous cell carcinoma (gingival).
  • False gingival enlargement, resulting from an increase in the size of the underlying osseous or dental tissues Gingiva: false gingival enlargement 01 Gingiva: false gingival enlargement 02 - radiograph.

Pathophysiology

  • In the case of inflammatory reaction of the gingiva:
    • Plaque accumulation on teeth → inflammatory reaction of gingiva → 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 Periodontitis.
  • 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, 160-169 PubMed.

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