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Differential Diagnosis & Pitfalls

• Granulomatous cheilitis – Can present with gingival hyperplasia that, on biopsy, contains non-necrotizing 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, erythematous, and bleeds readily.
• Kaposi sarcoma – Involves the gingiva and palatal tissues and has a purplish, dusky red appearance.
• Granulomatosis with polyangiitis – Gingiva has a pebbly, erythematous appearance, the so-called "strawberry gingivitis." Serologic markers for p-ANCA and c-ANCA are often positive.
• Condyloma – May occur on the gingiva, particularly in patients who have received organ transplantation. These have a pebbly, papillary, rough surface.
• Scurvy (vitamin C deficiency)
• 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 hyperplasia. 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.

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