As the title implies, there is a condition that might affect the gums known as gingival enlargements and it may result in the formation of false pockets. Its characterized by the increase in the bulk of the gums as result of certain systemic conditions or side effects of some drugs.
There many classifications of gingival enlargements, they occur as a result of:-
- Chronic Inflammation
- Adverse effects of certain drugs
- Enlargement associated with certain systemic diseases or conditions
- How chronic inflammation can cause gingival enlargements?
Chronic inflammation is the most common form of gingival enlargements, they occur due to prolonged irritation of the gums as a result of poor oral hygiene, misalignment of teeth, improperly contoured dental restorations, food impaction, irritation from orthodontics appliances & mouth breathing habit seen more commonly in the upper incisors, & canines.
They are painless unless complicated by infection or injury & they originate as slight ballooning of the margin of the gingiva or interdental papilla (the gums between the teeth) which is usually red or bluish red in color, bleeds easily & soft.
Treatment varies from patient to patient, in some cases, removal of the cause of the irritation may resolve the problem, others may require gingivoplasty (recontouring of the gums). Consult your periodontist to determine the best treatment plan for you.
- Gingival Enlargements as a result of adverse effects of drugs
There are certain drugs that may predispose to gingival enlargements such as:
- Phenytoin (Dilantin sodium)
- Sodium Valporate
(Refer to the chemical name of the drug rather than the trademark)
Phenytoin associated gingival enlargements is not related to the duration or concentration of the drug in saliva. It starts as beads like enlargements of the margins of the gums, these will unite and develop a massive fold covering most of the tooth and will often interfere with occlusion. The lesion is mulberry shaped, firm & pale pink with a small lobulated surfaces without tendency to bleed. It can be severe in the incisors and canines and occurs in areas where teeth are present. The enlargement is chronic, slowly increases in size and may recur after surgical removal.
Cyclosporine on the other hand is an immunosuppressive drug that has many side effects including, gingival enlargement, hypertension, hypertrichosis (increase in hair where it normally doesn’t present at specific sites of the body), & nephrotoxic (toxic to kidneys). Gingival enlargement here is more vascularized than Phenytoin associated gingival enlargement. It occurs in children more commonly and its magnitude is related to the concentration of the drug in the blood.
Nifedipine is a drug given to people with heart conditions and can induce gingival enlargements in 20% of the cases.
Treatment here will be based on the patients conditions, the reasons he/she is taking the drug & is done with the consultation from the patient’s physician.
- Hormonal Gingival Enlargement
The bulk of the gingiva can increase in puberty and pregnancy due to hormonal changes that occur during these periods. Pregnancy, however, doesn’t cause the condition, its just the altered tissue metabolism that can accentuate gingival enlargements. It can occur in 10-70% of the cases.
- Leukemic Gingival Enlargements
As the name implies, gingival enlargement can occur in patients with acute leukemia and in fact it can be a sign that the patient is suffering from leukemia if he hadn’t been diagnosed with. Gingival enlargements here is characterized by bluish red gingiva, moderately firm, bleeds spontaneously on slightest irritation, & can be complicated by Acute Necrotizing Ulcerative Gingivitis.
So, what do you know about bulky gums? I will read each and every comment.
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Haider Maitham, DDS