Gingival Hyperplasia Demystified: Types, Symptoms, And Histology

Gingival Hyperplasia Demystified: Types, Symptoms, And Histology

Question. Classify gingival hyperplasia. Describe clinical features and histopathology of idiopathic gingival hyperplasia.
Answer.

Classification of Gingival Hyperplasia

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Based on etiological factors and pathologic changes

• Inflammatory enlargement
  • Chronic
  • Acute
• Drug-induced enlargement
• Enlargement associated with systemic disease
  • Conditional enlargement
    • Pregnancy
    • Puberty
    • Vitamin C deficiency
    • Plasma cell gingivitis
    • Non-specific conditioned enlargement (Pyogenic granuloma)

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• Systemic diseases causing gingival enlargement
  • • Leukemia
    • Granulomatous disease (E.g. Wegener’s Granulomatosis, sarcoidosis)
• Neoplastic enlargement
  • • Benign tumors
    • Malignant tumors
• False enlargement

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Using the criteria of location and distribution, gingival enlargement is designated as follows:

• Localized: Gingival enlargement limited to one or more teeth.
• Generalized: Involving the gingiva throughout the mouth.
• Marginal: Confined to marginal gingiva.
• Papillary: Confined to the interdental papilla.
• Diffuse: Involving the marginal and attached papillae.
• Discrete: Isolated sessile or pedunculated tumor-like enlargement.

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Based on the degree of gingival enlargement

Grade 0: No sign of gingival enlargement.

Grade I: Enlargement confirmed to interdental papilla

Grade II: Enlargement involves papilla and marginal gingiva.

Grade III: Enlargement covers three-quarters or more of the crown.

drug-induced gingival hyperplasia

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Idiopathic Gingival Hyperplasia

• Idiopathic gingival enlargement is a rare condition of undetermined cause.
• It is also known as angiomatosis or elephantiasis gingivae or idiopathic fibromatosis or hereditary gingival hyperplasia, or congenital fibromatosis.

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Clinical Features

• Enlargement affects the attached gingiva, the gingival margin, and the interdental gingiva.
• Facial and lingual surfaces of the mandible and maxilla are affected.
• Involvement may be limited to one jaw.
• Enlarged gingiva is pink, firm, and leathery in consistency, with a minutely pebbled surface.
• In severe cases, teeth are completely covered by enlarged gingiva.

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Histopathology

• Epithelium is hyperplastic with elongation of rete ridges.
• Mild hyperkeratosis is also seen.
• The underlying connective tissue stroma consists of dense bundles of collagen and numerous fibroblasts.
• At times presence of chronic inflammatory infiltrate is seen.