Hereditary gingival fibromatosis
A 12 years old female child reported to the Department of Periodontics, Government Dental College and Hospital, Nagpur complaining of gingival swelling, which caused severe compromise in her speech, mastication and aesthetics and led to considerable disfigurement of her facial profile, owing to the severity of gingival enlargement. The patient reported that the gingival enlargement started with the eruption of permanent dentition but progressed slowly to cover the entire permanent dentition. No single tooth was visible due to enlargement in anterior region whereas only occlusal portions of teeth were visible in posterior region. It was difficult to predict whether the positions of teeth were hampered due to massive gingival mass. However, the panoramic radiograph revealed normal bone height and tooth positioning.\nThe extra oral examination revealed an exaggerated convex profile with highly incompetent lips as the tissue bulge was protruding out of the mouth. The intra oral examination revealed generalised gingival overgrowth including both maxillary and mandibular arches extending into the vestibular areas []. The pink, leathery consistency tissue was hard on palpation and covered complete crowns of the entire dentition. The intra-oral examination confirmed that the patient used to masticate with assistance from the gums, however, no ulcerations were found on the occlusal surfaces of the enlarged tissue. A scanty amount of plaque and food debris was entrapped into the posterior teeth which were partially visible amongst the entire dentition with no significant inflammation present around them.\nRoutine blood investigations were done and values were found within normal range although haemoglobin values was slightly below normal range (8.5 gms%). The blood group examination was also done owing to the need for blood transfusion which was deemed necessary for maxillary arch gingivectomy after complete clinical evaluation. Based on the provisional diagnosis, an incisional biopsy was done and sent for histopathological examination to confirm the diagnosis.\nThe patient's medical history did not reveal any drug induced gingival enlargement or hormonal changes and exhibited no signs of hypertrichosis or mental retardation that could be associated with gingival hyperplasia.\nHer family history was significant because her elder sister (15 years old) also revealed the presence of gingival enlargement but, was not willing for treatment as it was not causing any aesthetic and functional compromise. Her parents did not reveal any evidence of gingival overgrowth.\nThe enlarged tissue was removed by the external bevel gingivectomy under local anaesthesia quadrant wise only in the mandibular arch. Periodontal dressing was applied and chlorhexidine, haematinics and fortified B-Complex vitamins were prescribed for two weeks. For maxillary arch gingivectomy was performed under general anaesthesia. The patient was admitted to the hospital a day before the surgery where she was pre-medicated with requisite antibiotics and anti-inflammatory agents (Amoxicillin and Cloxacillin 500 mg, in divided doses 12 hourly and Piroxicam 20 mg, 8 hourly). There was significant blood loss during the surgery which was compensated by putting the patient on blood transfusion (2 pints of 350 ml each over 2 days). The post-operative instructions were reinforced and a custom made acrylic stent was placed against the surgical area containing periodontal dressing. The patient was discharged on the third day and was asked to continue with the medications till 7 days.\nThe histological evaluation of the section revealed moderately dense to highly dense collagenous connective tissue with collagen bundles arranged in haphazard manner. The connective tissue was relatively avascular with scanty inflammatory cells infiltrate. The overlying epithelium was hyper-plastic with enlarged rete ridges. The histopathological picture was suggestive of gingival fibromatosis [].\nPost-surgical healing was uneventful. The stent contained periodontal dressing was removed after one week. The surgical area was profusely irrigated with Betadine and normal saline. Post-operative instructions were reinforced and the patient was recalled after two weeks, one month and three month intervals for post-surgical evaluation. Post surgically her facial profile improved dramatically and the patient was satisfied with the result [].