There are three types: O Gingival abscess O Pericoronal abscess O Periodontal abscess. 5. O Among all the abscesses of the periodontium. “Regional” enlargements refer to involvement of gingiva around three or more . Histopathological examination of gingival/periodontal/pericoronal abscess may. The periodontal abscess is an acute destructive process in the periodontium the gingival sulcus or other periodontal sites and not arising from the tooth pulp.
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Gingival enlargement is one of the frequent features of gingival diseases. However due to their varied presentations, the diagnosis of these absea becomes challenging for the clinician. They can be categorized based on their etiopathogenesis, location, size, extent, etc. Based on the existing knowledge and clinical experience, a differential diagnosis can be formulated.
Subsequently, after detailed investigation, clinician makes a final diagnosis or diagnosis of exclusion. A perfect diagnosis is critically important, since the aabses of these lesions and prevention of their recurrence is completely abwes on it. Furthermore, in some cases where gingival enlargement could be the primary sign of potentially lethal systemic diseases, a correct diagnosis of these enlargements could prove life saving for the patient or at least initiate early treatment and improve the quality of life.
The purpose of this review article is to highlight significant findings of different tingiva of gingival enlargement which would help clinician to differentiate between them.
A detailed decision tree is also designed for the practitioners, which will help them arrive at a diagnosis in a systematic manner.
There still could be some lesions which may present in an unusual manner and make the diagnosis challenging. By knowing the existence of common and rare presentations of gingival enlargement, one can keep a broad view when formulating a differential diagnosis of localized isolated, discrete, regional or generalized gingival enlargement.
The diagnosis of these lesions is essential for their successful management and of the patient as a whole. This article revises the existing knowledge of different types of enlargements and highlights some important diagnostic features.
A customized decision tree is designed, which will help clinicians to keep a broad view when formulating a differential diagnosis of localized isolated, discrete, regional or generalized gingival gkngiva and arrive at a particular diagnosis is an easy and systematic manner.
Gingival enlargement or gingival overgrowth, a common trait of gingival disease, is characterized by an increase in the size of gingiva. Pertinent management depends on precisely diagnosing the origin of enlargement. Based on etiopathogenesis, enlargements could be inflammatory, drug influenced, those associated with systemic conditions or diseases, neoplastic or false enlargements.
According to location, enlargements could be marginal, papillary or diffuse.
Based on distribution they can be localized or generalized. Localized enlargements could be further divided into three sub-types, viz.
The purpose of this article is to highlight significant findings of different types of gingival enlargement which would help clinician to differentiate between them.
For the purpose of clinical diagnosis, enlargements mentioned in this review are grossly are divided into isolated lesions epulis and regional or generalized gingival enlargements. Among these, diagnostic points are discussed for the more commonly occurring lesions and the very rare and unusual presentation are listed as per the category to which they belong.
Frequent diagnosis in this category is inflammatory rather than neoplastic and may fall in one of the following group of reactive lesions: Most often the lesion is painless. Gingivaa may be associated due to secondary traumata via brushing, flossing or chewing. Fibrous epulis and its subtypes. Peripheral fibroma, presenting as pink firm, uninflammed mass growing from under the gingiva; B: Peripheral cementifying fibroma, a subcategory of fibroma, shows additional foci of avses C and D: Surgical exposure of the lesion showing extensive bone formation in the core of the lesion.
Also presence of bony trabeculae was seen histologically. Presents in adults as smooth surfaced mass, often ulcerated and grows from beneath the gingival margin.
Typically they grow rapidly within first few weeks and then slowly. Angiogranulomas may present as: Histologically, the stratified squamous epithelium is thickened, with prominent rete pegs and some degree of intracellular and extracellular edema, prominent intercellular bridges and leukocytic infiltration.
They occur particularly in anterior region in young gijgiva or in posterior mouth during mixed dentition phase and in adults.
They are very aggressive lesions with significant growth potential. The high vascularity of these lesions can be understood by their purplish-red color and tendency to bleed. Lesion of peripheral giant cell granuloma. This highly vascular lesion is characterized by purplish red-color and its tendency to bleed. Gingival cysts are unusual cysts of odontogenic source. A greater number of these are found on the labial attached gingiva of the mandibular anterior teeth.
Presence of fluid may give them a bluish hue and they may lead absess resorption of the labial bone due to pressure. Radiographically, its radiolucency may sometimes lead to confusion with lateral periodontal cyst.
Excisional biopsy is the best management for these lesions[ 4 ]. The localized epulis like lesions can also be classified as being benign or malignant.
Malignant tumors could be squamous cell carcinoma or melanoma. Other uncommon localized gingival enalargements which could be misdiagnosed as absrs. Hemangioma located in mandibular right quadrant; B: Mucocele associated with palatal minor salivary gland; C and D: A lateral periodontal cyst projecting labially and causing localized gingival enlargement.
The acute form of isolated gingival enlargement could be various abscesses such as gingival, periodontal, periapical or pericoronal. They can be differentiated from their location and vitality of the sbses tooth. Often the pericoronal flap covering distal most mandibular teeth might become inflamed and swollen.
Abscess presenting as localized gingival enlargement. Gingival abscess, near gingival margin or papilla; B: Ggingiva periodontal abscess, the swelling is diffuse; C: Periapical abscess, gingivq apex of concerned tooth; D: Abscess of pericoronal flap. The surface epithelium has varying degrees of intra- and extracellular edema, invasion by leukocytes, and sometimes ulceration.
More commonly, gingival disease manifests as regional or generalized gingival enlargement, which might fall into one of the abss types. These are inflammatory response to local giingiva associated with gingiva. The presentation begins as slight ballooning of the papilla or marginal gingiva, depending upon the location of the irritant.
The bulge may progressively increase in size and extent to become generalized. Clinical they may appear bluish or deep red. They absea frequently friable and soft with a smooth shiny surface and they usually bleed easily. Occasionally, chronic inflammatory enlargement may also present as firm, resilient, pink and fibrotic enlargement which histologically show abundance of fibroblasts and collagen fibers.
Plaque and calculus; B: Although considered as inflammatory, the exact mechanism of enlargement in mouth breathers is not clear. It is thought to be due to alternate wetting and drying of the gingival surface. The gingiva appears red and edematous with diffuse shiny surface.
A diagnostic feature of this type of enlargement would be presence of significant enlargement in maxillary and mandibular anterior regions and no involvement of posteriors. In a gigniva bimaxillary protrusion case, the enlargement will be limited to palatal aspect of maxillary anteriors and labial aspect of mandibular anteriors. Patients present with gingiga breathing habit that may be due ases short upper lip, hyperactive labii superioris, proclined incisors, rhinitis, etc. Drug induced gingival enlargement: Signs and symptoms related to gingival enlargement are seen within mo of initiation of drug intake.
Usually at the initial presentation there is no pain.
The enlargement starts as beadlike enlargement of the vingiva papilla and eventually may involve marginal gingiva. When not involved by secondary inflammation, the enlargement looks like mulberry shape, firm, pink and resilient with minute lobulations and no bleeding on probing. Although it may involve the gingiva around all teeth, it is more prominent in maxillary and mandibular anteriors.
It will be absent in edentulous areas and will disappear in areas where teeth are extracted. When infected secondarily, there is increase in the size of existing enlargement and adds characteristic features of inflammatory enlargement. Among commonly encountered drug induced gingival enlargement DIGOthose due igngiva immunosuppressive agent like cyclosporine, appear more vascularized than phenytoin induced[ 17 ]. Drug influenced gingival overgrowth.
Superimposed with secondary inflammation; B: When patients are in combination therapy, in which two or more drugs are known to cause gingival enlargement, then, which should be attributed to the diagnosis of DIGO, is a puzzle. In these cases, it becomes difficult to associate duration of occurrence of enlargement with related drug history.
Genetic disorders associated with gingival enlargement: They can be divided into 4 primary categories based on their anses, clinical features and histology. Idiopathic gingival enlargement is also referred to as congenital familial fibromatosis, gingivomatosis, idiopathic fibromatosis, elephantiasis and hereditary gingival hyperplasia.
It presents as unusual fibrotic gingival enlargement of localized or generalized extent. It may present as a specific entity or as a part of syndrome. Diagnosis can be made by a positive family history of gingival enlargement. It usually begins with the eruption of the primary or permanent dentition. A frequent finding could be presence of firm bulky enlargement of gingiva restricted to maxillary and mandibular second and third molar areas only.
Alveolar bone is rarely affected, but presence of pseudo-pockets and difficulty in maintaining oral hygiene may lead to some periodontal problems.
Gingival enlargement associated with syndromes in different types of genetic disorders. Unusual firm fibrotic gingival enlargements in a patient with hereditary gingival fibromatosis. Generalized gingival hyperplasia, during pregnancy and puberty, is influenced by hormonal changes that pretentious the response to local irritants.