IJCRR

IJCRR - 6(15), August, 2014

Pages: 53-56

Date of Publication: 10-Aug-2014

SURGICAL MANAGEMENT OF GINGIVAL ENLARGEMENT: A CASE SERIES

Author: Munaza shafi, Nawal khan, Prabhati Gupta, Reyaz Ahmed Mir, Nasrina Bashir

Category:

Abstract:Introduction: Gingival enlargement is defined as an overgrowth or increase in size of gingiva. Gingival enlargement is associated with multiple factors including inflammation, medications, neoplasia, hormonal disturbances and heredity. A case of gingival enlargement should be treated in a step-wise manner, including consultation with the patient's physician, substitution of the drug, nonsurgical therapy, surgical therapy (if needed), and supportive periodontal therapy after every 3 months. Case series: This case series presents diagnosis and management of amlodipine induced gingival hyperplasia and idiopathic gingival enlargement. Drug-induced gingival enlargement and idiopathic gingival enlargement was diagnosed and managed byscaling and root planing followed by gingivectomy with 6 months follow up Conclusion: Conventional gingivectomy with oral hygiene measures and regular followup is the treatment of choice for such
presentation.

Keywords: Drug- induced enlargement, idiopathic gingival enlargement, gingivectomy

Full Text:

INTRODUCTION
Gingival enlargement is defined as an abnormal growth of the gum tissue. It is associated with multiple factors including: inflammation, hormonal, drug use, neoplasm, genetic, systemic and idiopathic.(1,2,3) Gingival enlargement is one of the side effects associated with the administration of several drugs.(4) Currently, more than 20 drugs are associated with gingival enlargement. Drugs having side effect of gingival enlargement can be broadly divided into three categories: anticonvulsants, calcium channel blockers and immunosuppressant’s. Amlodipine-induced gingival enlargement is comparatively less prevalent among calcium channel blockers. Since pathogenesis of gingival enlargement is not well-understood, it is still a challenge for the periodontists to diagnose and manage the case effectively. Idiopathic gingival hyperplasia has been described in several case reports. The clinical presentation of the gingiva is pink, firm, fibrotic and nonhemorrhagic. Severity varies and may cover part/all of the crowns of the erupted teeth. General histological findings include normal overlying epithelium, rete pegs extending deep into underlying connective tissues with some areas of hyperplasia, proliferating dense fibrous CT with increased cellularity and coarse collagenous fiber bundles and hyperkeratosis and acanthosis with elongated papillae (5) The purpose of this paper is to present a case series of a patients with amlodipine induced gingival enlargement and idiopathic gingival hyperplasia and their management with 6 month follow up.

Case 1
A 47-year-old male was referred to the Department of Periodontics with complaints of gingival enlargement with foul odor, bleeding and fetid discharge from gums since 1 year. Gingival tissues were pale pink, enlarged, firm, and fibrotic .Generalized bleeding on probing was present. General examination revealed normal built. A diagnosis of generalized drug-induced gingival enlargement superimposed with periodontitis was made. With the consent of the patient and her physician, complete professional oral prophylaxis was performed, along with a prescription of a 0.2% chlorhexidine mouthwash (10 ml BID for 7 days). With the patient’s and physician’s

Conclusion
Successful treatment of drug induced gingival enlargement and idiopathic gingival enlargement depends on the proper identification of etiologic factors and improving oral hygiene status, esthetics, and function through elimination of local factors and surgical excision of the over growth.

Acknowledgement
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

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