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Gingival enlargement - Oral Mucosal Lesion
Other Resources UpToDate PubMed

Gingival enlargement - Oral Mucosal Lesion

Contributors: Haya Raef MD, Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Gingival enlargement is a diffuse enlargement of the gingiva that generally affects all 4 quadrants (upper-left, upper-right, lower-left, and lower-right quadrants). Depending on the etiology, it affects different age groups and populations.

Gingival enlargement may result from reactive gingival overgrowth or infiltrative processes.

Gingival overgrowth:
  • Plaque induced – The most common cause of gingival overgrowth is poor oral hygiene. The gingiva may become enlarged and edematous as a result of plaque-induced inflammation, an extension of common gingivitis.
  • Hormonal – Hormonal alterations, such as during puberty and pregnancy, can exacerbate gingival inflammation.
  • Drug induced – Medications including anticonvulsants (such as phenytoin), immunosuppressants (such as cyclosporine), and calcium channel blockers (such as nifedipine and diltiazem) are further culprits. The mechanism by which these drugs induce gingival enlargement is not fully understood, but fibroblastic proliferation has been suggested. Drug-induced gingival enlargement typically affects the anterior gingiva and usually occurs within 3 months of starting the medication. It occurs in 25%-50% of patients taking these medications. This affects patients with seizure disorders who are prescribed anticonvulsant medications (generally younger patients and adults) and those who have undergone organ transplantation and are on immunosuppressant medications, in particular renal transplantation (generally adults). Although poor oral hygiene plays an important role in drug-induced gingival enlargement, the variable severity in affected individuals likely indicates a genetic predisposition.
  • Vitamin C deficiency – This commonly presents with gingival enlargement with increased friability.
Gingival infiltration:
  • Granulomatous cheilitis – Can present with gingival enlargement that, on biopsy, contains nonnecrotizing granulomas. There is usually a history of and/or concomitant lip and facial swelling. Fissured tongue may also be present in the variant Melkersson-Rosenthal syndrome.
  • Oral leukemic infiltration – This is particularly prone to involve the gingiva, although other forms of leukemia may also do so. The gingiva is usually friable, soft, boggy, and erythematous and bleeds readily.
  • Kaposi sarcoma – Involves the gingiva and palatal tissues and has a purplish, dusky-red appearance.
  • Granulomatosis with polyangiitis – The gingiva has a pebbly, erythematous appearance, the so-called "strawberry gingivitis." Serologic markers for perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) and cytoplasmic ANCA (c-ANCA) are often positive.
  • Hereditary gingival fibromatosis – Usually present in childhood with a family history of this disorder. The gingiva is usually pink and fibrotic.
  • Juvenile hyaline fibromatosis – An inherited disorder that can cause gingival enlargement. There are usually concomitant nodular skin lesions.
  • Ligneous conjunctivitis – This is a rare inherited disorder of plasminogen deficiency leading to masses of granulation tissue on the gingiva containing fibrin.
Complications of gingival enlargement include cosmetic damage, functional difficulties (with chewing and speech), and gingival inflammation due to plaque accumulation. The patient may report that the gingiva bleeds during tooth brushing and flossing, and there may be pain and tenderness.

Codes

ICD10CM:
K06.1 – Gingival enlargement

SNOMEDCT:
54711002 – Gingival enlargement

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Oral mucosal wart – May occur on the gingiva, particularly in patients who have received organ transplantation. These have a pebbly, papillary, rough surface.
  • Periodontitis
  • Desquamative gingivitis
  • Orofacial herpes simplex virus
  • Necrotizing ulcerative gingivitis
  • Chronic ulcerative stomatitis – Resembles erosive lichen planus. Other oral mucosal sites are typically involved as well. Requires direct immunofluorescence (DIF) studies to confirm diagnosis.
  • Plasma cell gingivitis – Red, enlarged gingivae but no desquamation.
  • Oral papillomas of Cowden disease – 1- to 3-mm papules found on the gingiva and other mucosal surfaces in greater than 80% of patients. They may coalesce to form plaques with a cobblestone appearance.
  • Noma

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:03/27/2023
Last Updated:04/05/2023
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Gingival enlargement - Oral Mucosal Lesion
A medical illustration showing key findings of Gingival enlargement
Clinical image of Gingival enlargement - imageId=5007. Click to open in gallery.  caption: 'Hypertrophy of gums with overlapping of the teeth.'
Hypertrophy of gums with overlapping of the teeth.
Copyright © 2024 VisualDx®. All rights reserved.