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The multifactorial aetiology of gingival overgrowth: a case report illustrating diagnosis and management Rachael Y Jablonski Bethany Rushworth Kathryn A Durey Dental Update 2024 46:7, 707-709.
Authors
Rachael YJablonski
BDS MFDS RCSEd
Academic Clinical Fellow and Specialty Registrar in Restorative Dentistry, Leeds Dental Institute
Gingival overgrowth is the enlargement of gingival tissues and has various underlying aetiological factors. This case report highlights the multifactorial aetiology of gingival overgrowth for a patient who was prescribed an immunosuppressive strategy following renal transplantation, had poor levels of oral hygiene and a diet deficient in fruit and vegetables. The report highlights the importance of a detailed assessment to identify all underlying factors and demonstrates how a referral to the specialist services for gingival overgrowth led to a diagnosis of vitamin C deficiency. It also illustrates how both patient engagement and a conservative cause-related therapy can achieve a satisfactory resolution without any surgical intervention.
CPD/Clinical Relevance: This case report highlights the importance of a detailed assessment to diagnose all relevant underlying aetiological factors involved in the development of gingival overgrowth. It also illustrates how both patient engagement and a conservative cause-related therapy can achieve a satisfactory resolution of gingival overgrowth without any surgical intervention.
Article
Gingival overgrowth is a term used to describe a generalized or localized enlargement of the gingival tissues.1 Gingival overgrowth may be described according to the degree of gingival enlargement, distribution (localized or generalized), location (marginal, papillary or diffuse), or underlying aetiology. Gingival overgrowth can be classified using a variety of different descriptive scales. A gingival overgrowth index exists which evaluates both the degree of epithelial thickening and extent of encroachment onto the crowns of the adjacent teeth.2 Patients with severe gingival overgrowth may present with significant aesthetic concerns or impaired speech and mastication.3
Gingival overgrowth replaces the previously used terms ‘gingival hyperplasia’ (which refers to increased number of cells) and ‘gingival hypertrophy’ (referring to increased cell size).4 Histological evidence from patients with drug-induced gingival overgrowth found that the enlarged tissues had an abundance of apparently normal composition with no increase in cell density or size.4 Morphologic changes in the epithelium, vascular tissue and variable levels of chronic inflammation have also been noted.4,5 As a consequence, it has been suggested that gingival overgrowth is the most appropriate choice of terminology. This can be diagnosed clinically, often without the need for histological assessment.6
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