A case report on peripheral cemento-ossifying fibroma in South India.

Gingival enlargement is a common manifestation of gingival diseases and it is characterized by increase in size of the gingiva. A 20-year-old male reported with the primary complaint of swelling in lower front teeth region for the past 7 month. Patient noticed the swelling to be small when it started and gradually increased to attain the present size. There was no contributing history of bleeding or pain. Excision of the lesion was done using electrocautery followed by histopathological analysis. The challenge for clinicians lies in accurately diagnosing the underlying cause due to the diverse presentations of these conditions in this case report.

Development of a decision tree model for predicting the malignancy of localized gingival enlargements based on clinical characteristics.

The present study aimed to determine the prevalence of localized gingival enlargements (LGEs) and their clinical characteristics in a group of Thai patients, as well as utilize this information to develop a clinical diagnostic guide for predicting malignant LGEs. All LGE cases were retrospectively reviewed during a 20-year period. Clinical diagnoses, pathological diagnoses, patient demographic data, and clinical information were analyzed. The prevalence of LGEs was determined and categorized based on their nature, and concordance rates between clinical and pathological diagnoses among the groups were evaluated. Finally, a diagnostic guide was developed using clinical information through a decision tree model. Of 14,487 biopsied cases, 946 cases (6.53%) were identified as LGEs. The majority of LGEs were reactive lesions (72.62%), while a small subset was malignant tumors (7.51%). Diagnostic concordance rates were lower in malignant LGEs (54.93%) compared to non-malignant LGEs (80.69%). Size, consistency, color, duration, and patient age were identified as pivotal factors to formulate a clinical diagnostic guide for distinguishing between malignant and non-malignant LGEs. Using a decision tree model, we propose a novel diagnostic guide to assist clinicians in enhancing the accuracy of clinical differentiation between malignant and non-malignant LGEs.

Idiopathic Gingival Fibromatosis: Report of a Rare Case.

The progressive overgrowth of the gingiva is the hallmark of idiopathic gingival fibromatosis (IGF). Excess gingival tissue can obscure the crown of a tooth, resulting in spaces between teeth, displacement, retention of primary or permanent teeth, and difficulties with feeding, speaking, and appearance. The diagnosis and management of inherited gingival fibromatosis are the focus of this case report. A 12-year-old girl was referred from the Department of Orthodontics to Oral Medicine as a result of progressive gingival enlargement, which impeded orthodontic treatment for misaligned lower front teeth. The patient underwent a conservative periodontal treatment regimen that encompassed gingivectomy and debridement. The excised gingival tissues were submitted for histopathological examination. Tissue sections stained with hematoxylin and eosin showed connective tissue with dense bundles of collagen fibers and little inflammation. The patient was reviewed after three months, and advised of orthodontic management for further aesthetic correction. The findings indicated that the oral symptoms of gingival fibromatosis are influenced by the severity of the condition and the age at which it begins. Early intervention helps mitigate potential difficulties for younger individuals.

Surgical Management of Hereditary Gingival Fibromatosis: Case Series.

Hereditary gingival fibromatosis (HGF) is an uncommon genetic condition marked by gradual and progressive overgrowth of fibrous tissue in the gums, which is benign in nature. It is a genetic disorder inherited in an autosomal dominant pattern, known for its considerable genetic diversity. The marginal, attached, and interdental gingivae are affected by this condition. The affected area appears pink, does not bleed easily, and exhibits a firm, fibrotic texture. Additionally, it displays a hard, widespread nodular growth that is smooth to stippled and has little bleeding tendency. Nevertheless, in certain instances, the enlargement may feel so dense and firm that it resembles bone upon palpation. Accordingly, esthetics and functions related to a healthy gingiva is also affected. The choice of treatment modality often depends on factors such as the severity of gingival overgrowth, available resources, and patient-specific considerations. Laser techniques and electrosurgery have emerged as valuable options, providing benefits like reduced discomfort and enhanced precision. However, traditional surgical methods remain highly effective, particularly when advanced technologies are not available. This article reports on three cases of hereditary gingival fibromatosis (HGF) treated with conventional gingivectomy, flap procedures, and resective osseous surgery (osteoplasty and osteotomy). The aim is to support the efficacy of these interventions in addressing patient complaints and preparing the groundwork for managing additional issues, such as speech and mastication difficulties, delayed eruption of permanent teeth, and malocclusion. The surgical treatment led to significant improvements: masticatory function was markedly enhanced, aesthetic outcomes were notably better, and oral hygiene significantly improved. Additionally, the procedures created favorable conditions for future treatments, including orthodontics, implants, or prosthetics, by providing a more manageable and functional oral environment.

Management of Orthodontic Therapy-Associated Gingival Overgrowth for Esthetic Consideration in Anterior Maxillary Region: A Case Report.

Gingival inflammation and fibrous type of overgrowth, or a combination of both can lead to gingival enlargement (GE), and this negatively affects mainly masticatory function and esthetics, and sometimes causes psychological issues in patients. A typical characteristic of gingival diseases is gingival overgrowth, which can be brought on by fibrous overgrowth, gingival inflammation, or a combination of the two. It is a complex ailment arising from interactions between the environment and the host or different stimuli. Patients frequently have misaligned teeth, which encourages the buildup of bacterial plaque and unintentionally fuels gingival inflammation. Fixed orthodontic equipment can rectify this misalignment but they may also promote plaque buildup and the ensuing development of GE, gingival invaginations, and generalized hyperplastic gingivitis. The attachment of application and the rise in the amount of discernible supra- and subgingival plaque cause changes in microbial growth. Moreover, the force used in the treatment tends to activate the gingival soft tissue response. Clinical consequences such as persistent infection, inflammatory hyperplasia, gingival recession, attachment loss, or gingival overgrowth may arise after the device is placed. 'Plaque-induced' and 'non-plaque-induced' gingival disorders, such as gingival overgrowth, can be distinguished; however, a more precise fundamental etiology is frequently discernible. Several hereditary, systemic, or infectious diseases do not depend on plaque induction. Accompanying plaque accumulation in certain circumstances may make the clinical appearance worse. The case described here is of a 21-year-old female patient presenting with anterior maxillary GE associated with lateral incisors with orthodontic therapy. Surgical therapy was carried out to provide an excellent esthetic outcome for the patient.

Conventional Gingivectomy Procedure in the Management of Orthodontic-Induced Gingival Overgrowth: A Case Report.

Gingival enlargement (GE) can result from gingival inflammation, fibrous overgrowth, or a combination of both factors. Various etiological factors contribute to GE, including low-grade trauma, iatrogenic causes, drug-induced effects, systemic diseases, plaque accumulation, hormonal influences, vitamin deficiencies, genetic predispositions, and idiopathic reasons. Effective treatment in clinical practice hinges on accurately diagnosing the underlying cause. Among these, plaque-induced inflammation is the most common, driven by the accumulation of plaque and calculus. One challenge in maintaining oral hygiene is orthodontic treatment, which can impact speech, chewing, aesthetics, and psychological well-being. In this case report, a 21-year-old female patient developed GE associated with orthodontic appliance use. To address this, excess gingival tissue was surgically removed under local anesthesia using gingivectomy and gingivoplasty procedures, and the excised tissue was sent for histopathological examination. Following the surgery, a periodontal dressing (GC Coe Pack™) was applied to protect the tissue and aid in healing. The case underscores that enlarged gingival tissue, covering nearly half of the dental crowns, led to plaque accumulation and aesthetic concerns. Post-procedure, achieving a proper gingival contour eliminated suprabony pockets and enhanced the aesthetic appearance. The patient showed positive outcomes with no remaining suprabony pockets, resulting in a natural gingival contour, improved aesthetics, and reduced plaque retention. Surgical gingivectomy and gingivoplasty proved to be successful interventions in this case.

Antiproliferative effect of low-level laser/ photobiomodulation on gingival fibroblasts derived from calcium channel blocker-induced gingival overgrowth.

The aim of this study was to evaluate the antiproliferative properties of low-level laser therapy (LLLT) on gingival fibroblasts obtained from calcium channel blocker-induced gingival overgrowth (GO). Gingival fibroblasts of patients with GO were compared to healthy gingival fibroblasts (H). Both cells were exposed to LLLT (685 nm wavelength, 25mW power, diode laser) and compared to those not treated with LLLT. Cell proliferation and viability were measured with MTT assay at baseline and after 24 and 72 h. TGF-ß1, CTGF, and collagen Type 1 levels were evaluated with Enzyme-Linked Immunosorbent Assay (ELISA). LLLT significantly decreased the proliferation of GO fibroblasts (p < 0.05) while leading to a significantly higher proliferation in H fibroblasts compared to the untreated cells (p < 0.05). GO cells showed significantly higher CTGF, TGF-ß, and collagen Type 1 expression than the H cells (p < 0.05). LLLT significantly reduced CTGF levels in GO cells compared to the control group (p < 0.05). In H cells, CTGF and TGF-ß levels were also significantly decreased in response to LLLT compared to the control group (p < 0.05). While LLLT significantly reduced collagen expression in the H group (p < 0.05), it did not significantly impact the GO cells. LLLT significantly reduced the synthesis of the growth factors and collagen in both groups with an antiproliferative effect on the gingival fibroblasts from calcium channel blocker-induced GO, suggesting that it can offer a therapeutic approach in the clinical management of drug-induced GO, reversing the fibrotic changes.

Anti-proliferative impact of resveratrol on gingival fibroblasts from juvenile hyaline fibromatosis.

AIM: Resveratrol is a natural polyphenolic compound with biological activities such as anti-inflammation and antioxidation. Its anti-fibrotic effect has been experimentally demonstrated in the pancreas and liver. This study aims to determine the anti-proliferative effect of resveratrol on fibroblasts obtained from hyperplastic gingival tissues from a patient diagnosed with Juvenile Hyaline Fibromatosis (JHF). MATERIALS AND METHODS: Primary gingival fibroblast cell lines were obtained from gingival growth tissues by the gingivectomy of a patient with JHF. Gingival fibroblasts were treated with or without 3 different doses of resveratrol (50, 100, 200 µM). Cytotoxicity and cell proliferation were evaluated after 24, 48, and 72 h. Collagen, TGF, and CTGF were analyzed by ELISA in the 48-hour supernatants. RESULTS: All three doses of resveratrol suppressed the proliferation of JHF gingival fibroblasts at 24 and 48 h without showing any cytotoxic effect compared to the control group (p < 0.0001). At 72 h, 100 and 200 µM resveratrol showed significantly less proliferation (p < 0.0001), less collagen, CTGF, and TGF- ß (p < 0.001) than the control group. CONCLUSION: Resveratrol had a profound anti-proliferative effect on gingival fibroblasts obtained from gingival enlargements with JHF, suggesting that it can be used as a therapeutic to prevent excessive cell growth by suppressing collagen, CTGF, and TGF- ß synthesis in the pathogenesis of hyperplasia.

Multidisciplinary Management of Oral Manifestations in Pregnant Women with Beta-Thalassemia Major: A Case Report.

Introduction: Beta-thalassemia major is a blood disorder caused by impaired synthesis of hemoglobin beta chain. Oral manifestations of beta-thalassemia major in pregnancy have rarely been reported. Objective: This study aimed to describe a case of oral manifestations in a pregnant woman with beta-thalassemia major for multidisciplinary management. Case: A 27-year-old woman, suffering from beta thalassemia major who is undergoing therapy in the form of routine blood transfusions every month and taking anti-chelation drugs but is currently stopping this because she is pregnant, currently 16 weeks pregnant, complains complained of swollen gums, bleeding, and bad breath. Extraoral examination revealed dry, exfoliative lips. Intraoral examination revealed gingival hyperplasia with erythema, soft consistency, dark red rounded gingival margins, bleeding, true pockets and pain throughout the labial, buccal, palatal, and lingual. There was no history of systemic disease in this patient. Patient has never visited a dentist, either before or now, with complaints about her oral cavity. Hematological parameters showed abnormalities, and peripheral blood examination revealed an infection. The oral diagnoses included gingival enlargement and chronic periodontitis associated with pregnancy and ß- thalassemia major. Case Management: Dental management consisted of spooling with 3% hydrogen peroxide (H2O2) spooling, chlorine dioxide spray mouthwash, antibiotics, calculus removal, and oral hygiene instructions. Blood transfusions were administered once a month, and anti-chelation therapy was stopped during pregnancy. After three months of multidisciplinary management, the results were satisfactory. Conclusion: Multidisciplinary, collaborative dental and medical management with non-surgical therapy of oral manifestations in pregnant women with beta-thalassemia major showed satisfactory results.

Non-surgical Treatment of Severe Drug-Influenced Gingival Enlargement: A Report of Two Cases.

Drug-influenced gingival enlargement (DIGE) is a well-known adverse drug reaction associated with multiple medications. Although a benign condition, DIGE can have a significant impact on patients' aesthetic comfort and function. A surgical resection approach is usually proposed to treat severe and generalized DIGE. In this report, we describe the cases of a 47-year-old male and a 58-year-old male, both presenting with severe and generalized DIGE associated with amlodipine, a calcium channel blocker used for hypertension treatment. A non-surgical, cause-related approach, including drug substitution and repeated sessions of mechanical instrumentation, led to the complete resolution of severe DIGE, with no recurrence observed after 18 months in Case 1 and 12 months in Case 2. Throughout the observation period, the bleeding on probing score decreased from 100% at baseline to 10% or less, and the number of periodontal sites with probing pocket depth ≥ 5 mm decreased by more than 90% compared to the initial assessment. Both patients reported a high level of satisfaction with the treatment outcomes. These successful results should encourage clinicians to give greater consideration to non-surgical management of DIGE as a less invasive option before proceeding to surgical treatments.

The Unilateral Enigma: An Oral-contraceptive Related Gingival Enlargement.

This article's goal is to describe a case of oral contraceptives-related drug-induced gingival hypertrophy that was treated with nonsurgical and surgical periodontal therapy. The most prevalent negative side effect of systemic medicine on the periodontal tissues continues to be drug-induced gingival overgrowth. Specific regulatory molecules known as hormones control a variety of bodily processes. Gingival hypertrophies are sometimes linked to oral contraceptives that contain oestrogen and/or progesterone. A 32-year-old female presented with a complaint of swelling of the gingiva with spontaneous bleeding in the maxillary right quadrant region for a period of two months. The medical history documented the use of contraceptives for three months, and a clinical examination revealed the existence of poor oral hygiene and enlarged painful gingival tissues that bled when touched. Intraoral examination revealed that there was unilateral, generalized, diffuse gingival enlargement with pseudo pockets. Patient was diagnosed with gingival fibromatosis a based on the clinical, histological, and radiographic findings. The gingival enlargement was treated by conventional gingivectomy under local anaesthesia. The postoperative result was uneventful. Women who use oral contraceptives are a "risk group" for periodontal infections. On oral contraceptives, not every female reacts the same way. In periodontal therapy, plaque management is the most crucial step. Patient compliance is another element that affects a therapy's response. The patient demonstrated appropriate oral hygiene practices and adhered to home care guidelines adequately.

Nuclear receptor 4A1 (NR4A1) upregulated by n-butylidenephthalide via the mitogen-activated protein kinase (MAPK) pathway ameliorates drug-induced gingival enlargement.

Drug-induced gingival enlargement (DIGE) is a side effect of ciclosporin, calcium channel blockers, and phenytoin. DIGE is a serious disease that leads to masticatory and esthetic disorders, severe caries, and periodontitis but currently has no standard treatment. We recently reported that nuclear receptor 4A1 (NR4A1) is a potential therapeutic target for DIGE. This study aimed to evaluate the therapeutic effects of n-butylidenephthalide (BP), which increases the expression of NR4A1, on DIGE. In this study, NR4A1 mRNA expression was analyzed in the patients with periodontal disease (PD) and DIGE. We evaluated the effect of BP on NR4A1 expression in gingival fibroblasts and in a DIGE mouse model. RNA sequencing (RNA-seq) was conducted to identify the mechanisms by which BP increases NR4A1 expression. The results showed that NR4A1 mRNA expression in the patients with DIGE was significantly lower than the patients with PD. BP suppressed the upregulation of COL1A1 expression, which was upregulated by TGF-ß. BP also ameliorated gingival overgrowth in DIGE mice and reduced Col1a1 and Pai1 expression. BP also decreased Il1ß mRNA expression in gingival tissue in DIGE. RNA-seq results showed an increase in the expression of several genes related to mitogen-activated protein kinase including DUSP genes in gingival fibroblasts stimulated by BP. Treatment with ERK and JNK inhibitors suppressed the BP-induced increase in NR4A1 expression. In addition, BP promoted the phosphorylation of ERK in gingival fibroblasts. In conclusion, BP increases NR4A1 expression in gingival fibroblasts through ERK and JNK signaling, demonstrating its potential as a preventive and therapeutic agent against DIGE.

Electrocautery-Assisted Management of Unilateral Pyogenic Granuloma: A Case Report.

Pyogenic granuloma (PG) refers to an acquired benign proliferation most commonly seen within the oral cavity involving lips, palate, and gingiva. The term is misleading since it is a type of lobular capillary haemangioma but not an infection. It frequently recurs but lacks the capacity for malignant alteration. Depending on where the PG is located, one may experience discomfort or irritation. PGs often lead to differential diagnoses by clinicians, which include capillary hemangioma, neurofibroma, melanoma, and hyperplasia. Therefore, one must confirm a PG by diagnosing and analysing it by clinical and histopathological examinations, and treatment options should be formulated according to the evaluation. Sometimes, a biopsy of the lesion can be taken for final diagnosis. Various treatment approaches are available, including conventional scalpel excision, laser, electrocautery, and cryotherapy. Surgical excision is preferable due to the likelihood of malignancy, as it provides the best cosmetic appearance and produces a specimen for pathologic assessment. After confirming all the clinical evaluatory parameters and routine haematological examinations, which proved satisfactory and within normal ranges, this case of a 45-year-old female with soft tissue growth of the gingival origin was managed by electrocautery, and the PG was confirmed by a clinical-histopathological examination.

Drug induced gingival enlargement - phenytoin: an overview and case report.

Gingival enlargement is a side effect of several different medication, including immunosuppressants, anticonvulsants, and calcium channel blockers. It is an inflammatory response that starts when plaque and calculus build up on the tooth surface. The most prevalent long-term neurological condition affecting people is epilepsy. In affluent nations, the prevalence of epilepsy is ~ 1%, whereas in less developed countries, it may >2%. The preferred medication for the condition, phenytoin, has major side effects include gingival enlargement. In addition to being visually disfiguring, this enlargement frequently affects speech, chewing and eating. Furthermore, those with poor dental hygiene, causes disabilities with motor coordination and muscular limitations leading to mental disability and physical impairments are more prone to periodontal disease. This article enlightened the mechanism of drug induced gingival enlargement clinically, microbiologically, and surgically.

Giant cell angiofibroma of gingiva in tuberous sclerosis complex: a case report and literature review.

BACKGROUND: Tuberous sclerosis complex (TSC) is a rare, complex genetic disorder characterized by hamartomas and neoplastic lesions in various organ systems. With the development of radiology and gene testing, the diagnostic criteria for TSC were updated in 2012 at the International Consensus Conference. Intraoral fibromas have long been associated with TSC. However, the incidence of giant cell angiofibroma (GCA) in TSC patients is extremely rare. Here, we report the first case of GCA in the gingival tissue of a patient with TSC. CASE PRESENTATION: A 41-year-old woman first visited the Department of Oral and Maxillofacial Surgery, Chonnam National University Dental Hospital, complaining of gingival enlargement. Clinical examination revealed several manifestations associated with TSC, including intraoral fibromas, facial angiofibromas, dental enamel pits, ungual fibromas, "confetti" skin lesions, hypomelanotic macules, and a shagreen patch. Intraoral examination revealed a 6.0 × 5.0 cm gingival overgrowth on the left mandible. Surgical excision was performed, and subsequent histopathological examination confirmed the diagnosis of GCA. There was no evidence of recurrence within the 24- months of surgery. CONCLUSIONS: We report the first case of GCA in the gingival tissue of a patient with TSC. This report would contribute to an improved understanding of this rare disease. However, further case reports are necessary to clarify the relationship between GCA and TSC.

The Management of Drug-Induced Gingival Enlargement in a Patient With Preexisting Periodontitis.

Antihypertensives such as amlodipine, which is a family of calcium channel blockers (CCBs), possess a limitation by causing gingival enlargement on long-term use. Gingival enlargement hinders the patient's oral hygiene maintenance and causes more plaque accumulation and inflammation. The severity of the condition is dependent on dose and duration. When untreated, this leads to functional and esthetic disabilities. This is a case report of amlodipine-induced gingival enlargement in a young, chronic periodontitis patient who was under 5 mg of amlodipine for six months. Upon diagnosis, the patient underwent periodontal surgery and supportive periodontal therapy, which significantly improved her periodontal health in a one-year follow-up period.

Gingival overgrowth approached using recent mechanical and laser technologies: A case report.

Gingival enlargement is a side effect of different drug classes, with calcium channel blockers being among the most often cited examples. Most often accompanied by a disruption in the oral biofilm, this form of gingival overgrowth, with histological signs of hyperplasia and hypertrophy, becomes a chronic inflammatory condition with the oral biofilm a primary cause. This periodontal disease is now classified as 'dental biofilm-induced gingivitis', and its preferred name is drug-influenced gingival expansion. The present study presented the case of a patient with gingival enlargement while being treated with nifedipine for cardiac disease. This patient had factors that contributed to the retention of bacteria, ranging from poor oral hygiene practices to poorly adapted prosthodontics. After reducing these factors, a multimodal treatment was conducted, including bacterial mechanical decontamination through guided biofilm therapy protocol, laser bacterial decontamination, and surgical laser gingivectomy. The patient was referred to their cardiologist for substituting the calcium channel blocker medication. Clinical evaluations followed each treatment step. At 12 months, the patient presented positive, stable results, with an improvement in gingival status (no gingival overgrowth in the area where all risk factors were eliminated and minimal overgrowth in the area where old poorly marginally adapted prosthodontics were kept in place and no/minimal signs of gingival inflammation).

How much information regarding gingival enlargement can we get from TikTok and YouTube?

AIMS: This study aimed to evaluate and compare the reliability and quality of the information about gingival enlargements on YouTube and TikTok. METHODS: Two popular video sites, YouTube and TikTok, were searched for gingival enlargement and gingival hyperplasia. The reliability and quality of the first 300 videos for each search term, which is 1200 videos in total, were evaluated by social media video content evaluation tools: Global Quality Score (GQS) for quality and modified DISCERN for reliability. RESULTS: Health professionals uploaded 68.6% of the videos on YouTube and 54.5% on TikTok. It was observed that 50% of TikTok videos and 65.9% of YouTube videos were educational. In terms of quality, 2.7% of the videos on YouTube are of excellent quality, while in TikTok there are no videos of perfect quality. TikTok videos had considerably more views, likes, viewing rates, and interaction index scores than YouTube videos (P < 0.01). CONCLUSIONS: The videos and pieces of information on YouTube are more reliable and accurate in terms of gingival enlargement when compared to TikTok. Nevertheless, it was discovered that videos on both platforms were of poor reliability and quality in general.

Management of Chronic Inflammatory Gingival Enlargement: A Short Review and Case Report.

Inflammatory gingival enlargement, sometimes referred to as gingival hyperplasia or gingival hypertrophy, is an abnormal proliferation of gingival tissues caused by underlying inflammation. It might also be related to long-term periodontitis. Herein, we discuss the case of a young, otherwise healthy male patient wherein the anterior regions of both the upper and lower arches were affected by long-standing gingival growth. The overgrowth was removed, and an excellent aesthetic outcome was achieved, using a surgical procedure termed gingivectomy. After a 15-day follow-up period, the healing process was satisfactory and no negative effects were found.