Gingival hyperplasia is a diffuse overgrowth or 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.
The most common cause of gingival hyperplasia is poor oral hygiene. The gingiva may become enlarged and edematous as a result of plaque-induced inflammation, an extension of common gingivitis. This can occur in any individual but is exacerbated when there are super-imposed hormonal alterations such as during puberty and pregnancy. Another exacerbating factor is the ingestion of certain medications, Dilantin, cyclosporine, and calcium channel blockers (such as nifedipine and diltiazem) in particular. It occurs in 25-50% of patients taking these medications. This affects patients who have seizure disorders (generally younger patients and adults) and those who have undergone organ transplantation, in particular renal transplantation (generally adults). While poor oral hygiene also plays an important role in drug-induced gingival hyperplasia, patients also exhibit varying degrees of susceptibility to this that is likely genetically determined.
The patient may report that the gingivae bleed during tooth brushing, and there may be pain and tenderness.
The gingiva overgrowth usually occurs over weeks and months.
Codes
ICD10CM: K06.1 – Gingival enlargement
SNOMEDCT: 441798003 – Hyperplasia of gingiva
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Diagnostic Pearls
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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.
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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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.
