Classify Gingival Enlargement

Gingival Enlargement

What is gingival enlargement? Classify it and write in detail about conditioned gingival enlargement.
Or
Classify gingival enlargement and describe in detail about conditioned gingival enlargement.
Increase in the size of gingiva is known as gingival enlargement. It is a result of interaction between host and the variety of other factors.

Conditioned Gingival Enlargement

• Conditioned gingival enlargement occurs when systemic condition of patient exaggerates or distorts the usual gingival response to dental plaque.
• Bacterial plaque is necessary for the initiation of this type of enlargement.
• The three types of conditioned gingival enlargement are:
  • Hormonal (Pregnancy, puberty).
  • Nutritional (Vitamin C deficiency).
  • Allergic.

Conditioned Gingival Enlargement Types

Hormonal Enlargement in Pregnancy or Pregnancy Tumor

Gingival Enlargement Classification

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• Marginal enlargement
  • It results from aggravation of previous inflammation and does not occur without clinical evidence of local irritation.
  • Pregnancy does not cause this condition, the altered tissue metabolism in pregnancy accentuates the response to local irritation.
  • Clinical features:
    • Enlargement is generalized and tends to be more prominent interproximally than on facial and lingual surface.
    • Enlarged gingiva is bright red or magenta, soft and friable having smooth, shiny surface.
    • Bleeding occurs spontaneously.
• Tumor-like enlargement or pregnancy tumor
  • It is not a neoplasm but an inflammatory response to local irritation and is modified by patient condition. It appears after first trimester but may be early also.

Gingival Enlargement

Enlargement in Pregnancy or Pregnancy Tumor Clinical features

• The lesion appears as discrete, mushroom-like flattened spherical mass that protrude from interdental papilla or gingival margin and is attached by pedunculated base.
• Pregnancy tumor tends to expand laterally and pressure applied from tongue as well as cheek enhances the flattned appearance of pregnancy tumour.
• The color is dusky red or magenta with smooth glistering surface which exhibits numerous deep red, pinpoint markings.
• Consistency is semifirm, but has varying degrees of softness and friability.
• It is painless.

Enlargement in Pregnancy or Pregnancy Tumor Management

• The aim of periodontal therapy for pregnant patient is to minimize potential exaggerated inflammatory response related to hormonal alteration.
• Meticulous plaque control, scaling and root planning, polishing should be nonemergent periodontal procedures performed.
• Second trimester is the safest time in which treatment is performed.
• In conditions, like ‘supine hypertensive syndrome’ which occur during third trimester, in this appointment should be short and patient should change her position frequently.
• Fully reclining position should be avoided as far as possible.
• Medication and radiographs are avoided.
• In case of marginal and inter dental enlargement scaling and curettge is done.
• In case of tumor-like enlargement, surgical excision is done which is postponed until postpartum. During pregnancy, if it causes problem in mastication, it is removed on patients desire.

Enlargement in puberty

Enlargement in puberty Clinical features

• Enlargement is seen in marginal and interdental papilla and is characterized by prominent bulbous interproximal papilla.
• Frequently only the facial gingiva is affected, because mechanical action of tongue prevents accumulation of food on lingual surfaces.
• 11 to 7 years show high prevalence of gingiva enlargement.

Enlargement in puberty Management

• Scaling, curettage and oral hygiene instructions.
• Surgical removal in severe cases.

Classification Of Gingival Enlargement

Nutritional, i.e. Vitamin C deficiency Enlargement

Acute vitamin C deficiency does not itself cause gingival inflammation but it causes hemorrhage, collagen degeneration and edema of gingival connective tissue. These changes modify response of gingiva to plaque.

Deficiency Enlargement Clinical features

• Gingival enlargement is marginal, bluish red, soft friable and have smooth, shiny surface.
• Hemorrhage occurring either spontaneously or on provocation.
• The surface necrosis with pseudomembrane formation are common features.

Allergic, i.e. Plasma Cell Gingivitis

It is thought to be allergic in origin, possibly related to the components of chewing gum, dentifrices or various diet components.

Plasma Cell Gingivitis Clinical features

• It consist of mild marginal gingival enlargement that extends to the attached gingiva.
• Gingiva appears red, friable and bleeds easily. An associated cheilitis and glossitis is seen.

Plasma Cell Gingivitis Management

• Scaling, curettge and oral hygiene functions
• Surgical removal in severe cases.