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CASE REPORT
Year : 2016  |  Volume : 1  |  Issue : 1  |  Page : 48-50

Localized longstanding chronic inflammatory gingival overgrowth - A case report


1 Assistant Professor, Department of Periodontics & Community Science, College of Dentistry, King Khalid University, Abha, K.S.A
2 Assistant Professor, SDS, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
3 Assistant Professor, Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
4 Assistant Professor, Division of Periodontics, Department of PCS, College of Dentistry, King Khalid University, Abha, K.S.A
5 Postgraduate student, Department of Periodontics, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India

Date of Web Publication7-Aug-2020

Correspondence Address:
BDS, MDS Shankar T Gokhale
Division of Periodontics, Department of PCS, College of Dentistry, King Khalid University, Abha
K.S.A
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Source of Support: None, Conflict of Interest: None


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  Abstract 


We report a young patient who presented with longstanding gingival swelling. Based on the clinical, radiological, and histopathology findings following excision, a diagnosis of localized longstanding chronic inflammatory gingival overgrowth was made. Chronic longstanding inflammatory gingival overgrowth might be seen either localized or generalized owing to fibrosis. It might mimic the appearance of idiopathic gingival overgrowth. Generally, these overgrowths are painless, appear pale pink in color, vary in size and are leathery firm in consistency. Careful examination & proper history would help us in diagnosis and treatment planning.

Keywords: gingival overgrowth, hamartoma, reactive hyperplasia


How to cite this article:
Gokhale ST, Chaturvedi S, Bavabeedu SS, Reddy N R, Agrawal A. Localized longstanding chronic inflammatory gingival overgrowth - A case report. King Khalid Univ J Health Scii 2016;1:48-50

How to cite this URL:
Gokhale ST, Chaturvedi S, Bavabeedu SS, Reddy N R, Agrawal A. Localized longstanding chronic inflammatory gingival overgrowth - A case report. King Khalid Univ J Health Scii [serial online] 2016 [cited 2020 Oct 23];1:48-50. Available from: https://www.kkujhs.org/text.asp?2016/1/1/48/291600




  Introduction Top


Gingival overgrowth, which involves the excessive growth of gingival tissue, has several causes, including poor oral hygiene, medications, systemic diseases and hormonal changes. These lesions produced can be generalized or localized. A slowly progressive fibrous enlargement of the maxillary and mandibular gingiva is a feature of fibrous hyperplasia of the gingiva.[1] Characteristically, this massive gingival enlargement appears to cover the tooth surfaces involving the gingival margin and the inter-proximal spaces also. Its massive extension may also displaces the teeth with their crowns fully covered by the massive growth compromising the functions and esthetics. The exact pathophysiology of chronic or idiopathic gingival hyperplasia is not known but the presence of local irritants that are plaque and calculus play the most important role. The diagnosis is made when no other known causative factors can be identified.[2] Long term follow up of the patients is required to prevent reoccurrence of the lesion. Here we present a case report of gingival fibrous hyperplasia.[3]


  Case Report Top


A 18 year old male patient reported to the Department of periodontics with a chief complaint of restrictive tongue movement owing to presence of painless swelling in relation to right lower lingual aspect of the gingiva since 10 months [Figure 1]a.
Figure 1: a) Gingival overgrowth associated with poor oral hygiene, b) Occlusal view radiograph showing no pressure resorption, c) Pre operative view of gingival overgrowth after scaling, d) width of excised lesion, e) Length of excised lesion, f) Under scanner view

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The patient was apparently well when he first noticed the swelling 10 months back. To start with, the swelling was peanut in size & slowly progressed to attain the present size. There was no history of any other swelling in any other parts of the body intra-orally or extra-orally. His medical & family history was non-contributory.

Clinical examination

Extra-oral examination:

Facial appearance seemed to be bilaterally symmetrical. Lymph nodes were not palpable & there was no sign of any swelling extra-orally.

Intra-oral examination

Inspection:

A solitary exophytic nodular swelling was visible in relation to right lingual gingiva of mandibular region extending from central incisor to third molar region measuring about 4.5 cm x 1.5 cm. The overgrowth also extended up to the 2/3 rd of all the crown area. The colour was pale pink & surface seemed to be smooth. Oral hygiene status was found to be poor.

Palpation:

The inspectory findings regarding number, site, shape & size were confirmed. The lesion was found to be sessile with broad base, leathery firm in consistency & non-tender.

Radiographic findings:

Occlusal radiographic view of the mandible showed no bone loss which could have happened owing to pressure resorption [Figure 1]b.

Diagnosis & Treatment:

Based on clinical & radiographic examination, diagnosis of Chronic longstanding inflammatory gingival overgrowth was made & decision was taken to perform the excisional biopsy of the complete lesion.

The treatment procedure was explained to the patient and accordingly written consent was obtained. To start with Phase I therapy with thorough scaling was carried out [Figure 1]c. After 3-4 weeks following scaling, Exicisional Biopsy was carried out in-toto under local anesthesia containing 2% lignocaine with 1:80000 epinephrine and the gingiva was excised till the desired crown lengthening was achieved [Figure 1]d & [Figure 1]e.

After the surgery, the site was irrigated with normal saline and a periodontal dressing was given. The patient was advised to take antibiotic: Amoxicillin 500 mg tid for 5 days and analgesic & anti-inflammatory: Ibuprofen 400 mg tid for 3 days and to rinse twice daily with 0.2% Chlorhexidine mouthwash for two weeks.

Histopathological Examination:

The excised gingival tissue was sent for the histopathological evaluation.

Under scanner view:

The Haematoxylin & Eosin staining of the specimen shows multiple bits of tissue showing epithelium (with retepegs) overlying fibrous connective tissue stroma (hyalinised in few areas). In some areas epithelium shows pseudoepitheliomatous hyperplasia [Figure 1]f.

Under Low power & High power view:

The epithelium is stratified squamous parakeratinized type. Connective tissue stroma shows loose to dense collagen fibre bundles with predominantly spindle and few plump shaped fibroblasts. Mild inflammatory infiltrate along with few endothelial lined blood vessels with RBCs are also evident [Figure 2]. These findings led to the final diagnosis of fibrous hyperplasia.
Figure 2: Under Low power & High power view

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The post operative healing was uneventful showing normal scalloped gingival contour after 6 months post surgery [Figure 3].
Figure 3: Post operative view after 6 months

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  Discussion Top


The final diagnosis of the lesion was based upon the clinical and radiographic features and histopathological report. It is being made by exclusion of other conditions, as the patient revealed no relevant genetic, drug induced or other relevant medical history. The amount of local factors present favoured the diagnosis of inflammatory fibrous hyperplasia rather than the idiopathic gingival enlargement.

The hyperplastic response in gingival fibrous hyperplasia does not involve the periodontal ligament and it occurs peripheral to the alveolar bone within attached gingiva. Same features were observed in the present case as it was restricted to only marginal and attached gingiva and no alveolar destruction was present.[4]

The enlarged gingiva is usually of normal pink color. The enlargement may be localized to specific areas of the mouth, typically the labial gingiva around the lower molars or may be generalized. Severity of the enlargement may vary from mild involvement of few teeth to severe involvement of all the teeth.[3] It may be segmental or uniform and marked enlargement affecting one or both of the jaws.[4] In the case presented, there was marked enlargement of gingiva of the right mandibular lingual teeth region extending from right mandibular central incisor to distal of third molar region only and very mild enlargement of gingiva of the right labial mandibular posterior teeth as the local irritants present in this patient were found to be in large amount in the right mandibular lingual teeth region only as compared to the other regions in the oral cavity. Why only some patients have a propensity for the development of connective tissue hyperplasia in response to local factors is unknown. Recent studies have stated a possible role for keratinocyte growth factor (a member of the fibroblast growth factor family) in this condition.[5]

Other conditions such as hormonal changes and drugs can significantly potentiate or exaggerate the effects of local factors on gingival connective tissue.[5] In the present case the enlargement was leathery firm in consistency with pale pink colour with abundant of local irritants. No displacement of teeth was found, around the lesion suggesting the absence of pressure exertion. So, all these features were very much in favour of diagnosis of fibrous gingival overgrowth.


  Conclusions Top


We have presented a patient suffering from Localized longstanding chronic inflammatory gingival overgrowth Reactive conditions are derived from mesenchymal cells and are represented by fibrous hyperplasias or exuberant proliferations of granulation tissue. These are slowly progressive and if untreated can lead to progressive destructive periodontal disease. So early intervention is required to prevent periodontal destruction. Long term follow up of such kind of patients are required to prevent reoccurrence of the lesions.



 
  References Top

1.
Pallagatti S, Sheikh S, Aggarwal A et al. Gingival Fibrous Hyperplasia- A Case Report, Nat J Med Dent Res 2013; 1(2): 26-30.  Back to cited text no. 1
    
2.
Reddy R, Jain U, Agarwal S et al. Idiopathic Gingival Enlargement- An Inter-Disciplinary Approach, Int J Den Clin 2011; 3(1): 92-93.  Back to cited text no. 2
    
3.
Mathur LK, Bhalodi AP, Manohar B et al. Focal fibrous hyperplasia: A Case Report, Int J Dent Clin 2010; 2(4): 56-57.  Back to cited text no. 3
    
4.
Jaju PP, Desai A, Desai RS et al. Idiopathic Gingival Fibromatosis: Case Report and Its Management, Int J Dent 2009; Article ID 153603: doi:10.1155/2009/153603.  Back to cited text no. 4
    
5.
Regezi JA, Sciubba JJ, Jordan RCK. Oral pathology: clinical pathologic considerations. 4th ed. WB Saunders: Philadelphia, 2003.p.115-16.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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