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Gingival Enlargement – Deborah Lyle Waterpik®

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  Posted by: The Probe      18th February 2019

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Gingival Enlargement

Dental practitioners frequently observe both localised or generalised gingival enlargement with a variety of presentations. Investigation and correct diagnosis of these lesions and enlarged tissues is vitally important in order to manage them successfully and to preserve both oral and general health. Here we discuss the main types of gingival enlargement and its associated causes:

 

Inflammatory-induced gingival enlargement

Gingival enlargement is most commonly an inflammatory response to prolonged exposure of bacterial plaque often brought about by poor oral hygiene levels. The gums appear red, soft with a smooth shiny surface and usually bleed easily. This type of swelling or enlargement can progress slowly and painlessly and can be exacerbated by local factors such as tooth displacement, overhanging crowns or restorations, ill fitting prostheses or by fixed orthodontic devices.[1],[2]

Also considered inflammatory is gingival enlargement in patients that have a habit of breathing through the mouth. This type of swelling appears red with a diffused shiny surface and is usually isolated to the anterior regions. It is thought to be caused by the dehydration or the alternate wetting and drying of the gingival surface.

 

Gingival enlargement associated with systemic disease

The gingival inflammatory reaction can also be influenced by systemic and endocrine factors. For example, the hormonal fluctuations associated with pregnancy, puberty and menopause can promote the growth of periodontal pathogens and make the gingiva more permeable and susceptible to inflammatory mediators.[3]Diabetes can also activate the pro-inflammatory response as well as Vitamin C deficiency, which is commonly associated with smoking and stress.[4]

Other conditions and diseases associated with enlargement, lesions or swelling of the gingiva include granulomatous diseases such as Wegener’s granulomatosis. This disorder causes inflammation of the blood vessels in the nose, sinuses, throat, lungs and kidneys. Reddish-purple granular lesions are characteristic of this condition and a dental practitioner may be the first professional to observe ‘strawberry gingivitis’, which may be significant in the timely diagnosis of this potentially fatal condition.[5]

Crohn’s disease also has oral manifestations in around 60 per cent of cases. Patients may present with swollen lips, soreness or inflammation of the tongue, fissuring and deep oral ulceration.[6]A pink, firm, minutely pebbled gingiva may also be a sign of Crohn’s disease.3

Often mimicking inflammatory-induced gingival enlargement, generalised gingival swelling is associated with leukaemia and is the result of the infiltration of leukemic cells within the gingival connective tissue. Oral manifestations occur in 65 per cent of patients with leukaemia and although it is hard to predict in individual patients, it can cause progressive enlargement of the interdental papillae, which can extend to cover the crowns of the teeth in severe cases. Patients may also present with mucosal ulcers and/or pale oral mucosa with gingival bleeding.[7]

 

Drug-induced gingival enlargement

This is another fairly common type of gingival enlargement or overgrowth in which the gingival tissues become swollen, though they usually remain firm, pale pink and do not bleed easily. Certain types of drugs, namely anti-convulsant/anti-seizure drugs such as phenytoin; immunosuppressiveagentslike cyclosporine; and calcium blocking agents such as nifedipine, all have notable side effects.2,[8]

Typically gingival enlargement appears between one and three months after beginning the medication. It may develop firstly with bead-like swelling in the interdental papilla and then extend to the marginal gingiva and onto the tooth surfaces. In severe cases, gingival enlargement can extend as far as the crowns of the teeth and impair the patient’s ability to speak and eat and for obvious reasons, it causes aesthetic concerns. With a significant increase in tissue, the patient is likely to have difficulty maintaining adequate oral hygiene and, as a result of plaque retention, gingival and periodontal inflammationtends to occur.

 

Hereditary Gingival Fibromatosis

This is a rare condition that can occur alone or along with other symptoms as part of a syndrome. It normally appears as either the primary or permanent teeth erupt and can cause excessive growth or enlargement of the gingival tissues to varying degrees. This can cause displacement of the teeth and spacing or over retention of primary teeth.[9]Enlargements can be pink or reddish and firm, which can cause both functional and periodontal concerns due to the challenge of maintaining adequate oral hygiene levels.3

 

False gingival enlargement

Occasionally enlargements can appear due to an increase in the underlying bony or dental tissues, such as when a tooth is erupting. There may be no other clinical symptoms except the size of the gingiva.

Plaque control is an essential part of management in all cases. As well as tooth brushing, the Waterpik®Water Flosser may help patients to overcome these challenges and equip them with the means to improve gingival health. The Waterpik®Water Flosser is significantly more effective than string floss for removing plaque.[1]In fact, studies show that it is up to 93 per cent better in reducing bleeding and up to 52 per cent at reducing gingivitis than traditional dental floss.[2]The Waterpik®Water Flosser has also been shown to reduce pro-inflammatory mediators along with bleeding on probing and probing pocket depths when compared to traditional oral hygiene measures.[3]

An excellent home care routine as well as regular dental checks is vital to ensure that gingival enlargement is not exacerbated but properly diagnosed and managed successfully.

 

For more information on Waterpik®please visit www.waterpik.co.uk. Waterpik®products are available from Amazon, Costco UK, Boots.com and Superdrug stores across the UK and Ireland.

 

 

REFERENCES

[1]Goyal CR, Lyle DM, Qaqish JG, Schuller R. Evaluation of the plaque removal efficacy of a water flosser compared to string floss in adults after a single use. J Clin Dent 2013;24:37-42. https://www.ncbi.nlm.nih.gov/pubmed/24282867[Accessed 6thAugust 2018]

[2]Barnes CM et al (2005) Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis, and supragingival plaque.J Clin Dent 16(3):71-7https://www.ncbi.nlm.nih.gov/pubmed/16305005[Accessed 6thAugust 2018]

[3]Cutler C, Stanford TW, Abraham C, et al. Clinical benefits of oral irrigation for periodontitis are related to a reduction of pro-inflammatory cytokine levels and plaque. Journal of Clinical Periodontology 2000;27:134-143. https://www.ncbi.nlm.nih.gov/pubmed/10703660[Accessed 6th August 2018]

[1]Dannewitz B. Proliferation of the gingiva: aetiology, risk factors and treatment modalities for gingival enlargement. Perio 2007;4(2) 83-92. https://perio.quintessenz.de/perio_2007_02_s0083.pdf[Accessed 1st August 2018]

[2]Agrawal A.A. Gingival enlargements: Differential diagnosis and review of literature. World J Clin Cases. 2015 Sep 16; 3(9): 779–788. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568527/[Accessed 1stAugust 2018]

[3]Bhardwaj A. et al. Effect of menopause on women’s periodontium.J Midlife Health. 2012 Jan;3(1):5-9. https://www.ncbi.nlm.nih.gov/pubmed/22923973

[Accessed 1stAugust 2018]

[4]Chambial S. et al. Vitamin C in Disease Prevention and Cure: An Overview. Indian J Clin Biochem. 2013 Oct; 28(4): 314–328. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783921/[Accessed 1st August 2018]

[5]Stewart C. et al. Oral manifestations of Wegener’s granulomatosis: a report of three cases and a literature review. J Am Dent Assoc. 2007 Mar;138(3):338-48. https://www.ncbi.nlm.nih.gov/pubmed/17332039[Accessed 6th August 2018]

[6]Walton R. Clinical Review Oral manifestations of Crohn’s disease. BMJ 2014; 349:g6670. https://www.bmj.com/content/349/bmj.g6670/rr/797707[Accessed 6thAugust 2018]

[7]Deliverska E.G. et al. Oral signs of leukemia and dental management – literature data and case report. Journal of IMAB 2013;19(4) 388-391. https://www.journal-imab-bg.org/issue-2013/issue4/JofIMAB2013vol19b4p388-391.pdf[Accessed 6thAugust 2018]

[8]Brown R.S et al. Mechanism for drug-induced gingival overgrowth revisited: a unifying hypothesis. Oral Dis. 2015 Jan; 21(1): e51–e61.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241888/[Accessed 6thAugust 2018]

[9]Aghili H. et al. Hereditary Gingival Fibromatosis: A review and a report of a rare case. Case Reports in Dentistry. Jan 2013. Article ID 930972. http://dx.doi.org/10.1155/2013/930972/Accessed 6th August 2018]


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