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gingival enlargement

(gingival overgrowth, hypertrophic gingivitis) An increase in the size of the gingiva (gums). (Types) • Inflammatory enlargement (most common) • Drug induced enlargement • Enlargement associated with systemic conditions or diseases (Types: Inflammatory enlargement) Tissue edema and infective cellular infiltration. Gingivitis. The gingivae are soft and discolored. (Causes) • Accumulation and retention of bacterial plaque. (Risk factors) • poor oral hygiene: Bacterial plaque. • physical irritation: Iimproper restorative and orthodontic appliances, surface dehydration by mouth breathing. (Treatment) • conventional periodontal treatment: Scaling and root planing or gingivectomy (surgical removal of the excess tissue). Improve oral hygiene. (Types: Drug induced enlargement) Caused by administration of drugs. (Causes) • anticonvulsants: Phenytoin (most common), phenobarbital, lamotrigine, vigabatrin, ethosuximide, topiramate, and primidone. Not common for valproate. • immunosuppressant: Cyclosporine (second most common). Much less severe for tacrolimus (but it is nephrotoxic). • calcium channel blockers (antihypertensives): Nifedipine (dihydropyridine class), amlodipine, and verapamil. Not for isradipine (dihydropyridine class). (Treatment) • Ceasing culprit drug or substituting to another drug. (Types: Enlargement associated with systemic conditions or diseases) Some are related to systemic conditions and others, diseases. (Causes) • Systemic conditions: Pregnancy, puberty, vitamin C deficiency, nonspecific (e.g. pyogenic granuloma). • Systemic diseases: Leukemia, granulolomatous diseases (e.g. granulomatosis with polyangiitis, sarcoidosis, orofacial granulomatosis), neoplasms (neoplastic enlargement) (e.g. fibromas, papillomas, giant cell granulomas, carcinoma, malignant melanoma), underlying bony or dental tissue lesion (false enlargement). (Comparison) • epulis: The lump situated on the gingiva locally. • gingival enlargement: The enlargement is over the whole gingiva. Cf. gingivitis, periodontitis