Long term follow up of idiopathic gingival enlargement associated with chronic periodontitis: A case report and review
A 30-year-old male reported to the outpatient department of Periodontics, SDMCDSH, Dharwad, India, with the complaint of swollen and bleeding gums, foul breath, and esthetic deformities of face. Patient noticed swollen gums 2 years back. Since it was asymptomatic, patient neglected it. The lesion started as a small painless, beadlike enlargement. As the enlargement progressed it resulted into a massive tissue fold covering considerable portion of the crowns, interfering with mastication and speech. Besides these, no other complaints were present, such as pain. Patient's past dental, medical, and drug history were non-contributory. Further questioning revealed that none of his family members were affected with any form of gingival enlargement, nor was there any familial history of aggressive periodontitis, hypertrichosis, mental retardation, or epilepsy. All the parameters in the hematological investigations were within normal limits. His height and weight were within normal limits.\nExtraoral examination revealed asymmetry of the face but there were no findings of lymphadenopathy. Intraoral examination revealed massive, generalized diffuse type of gingival enlargement involving both maxillary and mandibular arches, encroaching buccal, palatal, and lingual vestibular spaces [Figure -]. The lesion extended up to the level of occlusal plane. Gingiva was pale pink and firm in consistency with pebbled surface. No signs of acute inflammation were present. In addition, halitosis was accentuated. Periodontal examination revealed the presence of a thick band of microbial dental plaque and calculus subgingivally, generalized bleeding on probing, generalized mobility of teeth, malpositioning of upper anteriors, and generalized probing pocket depth in the range of 7 and 10 mm [Figure and ]. Consistent with these findings, panoramic radiograph revealed severe generalized alveolar bone loss indicating severe form of periodontal disease []. Examination of immediate family members of the patient revealed that, none of his family members were affected with severe form of periodontal disease suggesting a negative history for aggressive periodontal disease, confirming recorded history. Histopathological investigations of the excised tissue revealed atrophic parakeratinized stratified squamous epithelium with the dense avascular fibrocollagenous tissue [].\nIn the present case, the enlargement was not related to hereditary, syndromes, drugs, conditions, or endocrine problems. Severity of gingival enlargement was not consistent with the amount of local factors present and the presence of local factors might be secondary to gingival enlargement, as massive gingival enlargement interferes with proper oral hygiene. Histological examination of the excised tissue was suggestive of non-inflammatory gingival enlargement. Based on the history, clinical, radiological, and histopathological examination, a diagnosis of idiopathic gingival enlargement with generalized chronic periodontitis was made.\nEleven teeth were extracted due to hopeless prognosis. Examination of extracted teeth revealed root resorption of molars and the presence of thick band of subgingival calculus covering the entire length of the roots. Clinical inflammation was minimal after scaling and root planing. Surgical therapy included internal bevel gingivectomy combined with the open flap debridement under local anesthesia, which was performed at an interval of 1 month. The recovery period was uneventful. Function and esthetics were restored early with removable partial dentures. The patient showed no evidence of recurrence during 1 year follow-up period []. Three more teeth were extracted due to hopeless prognosis at 3 years follow-up and scaling was done for the remaining teeth. At the most recent follow-up, 5 years after the procedure, recurrence of the gingival enlargement was observed in the lower right quadrant, and anteriors []. The appearance of the tissue was quite similar to that seen at the beginning. Re-evaluation revealed the presence of plaque and calculus and periodontal pockets.