Unusual gingival enlargement with aggressive periodontitis: a case report

This article describes the surgical management of a young, female patient with severe gingival enlargement of unknown etiology.

Gingival enlargement frequently occurs as gingival hyperplasia, representing a reaction to a known stimulus or agent and, histopathologically, implies an increase in both extracellular matrix and cell numbers. The enlargement may range from mild, in which gingival architecture is minimally affected, to severe, in which the gingiva becomes bulbous and covers the clinical crowns of teeth. A number of local and systemic factors, such as plaque, hormonal changes, drug ingestion, and heredity, can cause or influence gingival enlargement. Mild to moderate increase in gingival bulk is relatively common, but massive gingival enlargement with associated bone resorption is rare.

This case involved a 19-year-old female patient who presented with generalized severe gingival enlargement with aggressive periodontitis, a condition of some five to six months in duration.

Based on a thorough clinical and radiographic examination, laboratory tests, and oral hygiene instructions, an internal bevel gingivectomy was performed to remove excess gingival tissue and areas of bone loss were debrided properly. There was no recurrence eight months following the last surgery.

Although we were not able to identify the exact cause of the gingival enlargement, amelioration of the unusual very soft, friable, enlarged gingivae and the severe periodontal attachment loss was observed.

Before initiating any periodontal management of a case of severe gingival enlargement with aggressive periodontitis, it is recommended to perform a complete extraoral and intraoral examination with radiographs, take a family and medical history, and determine if any medications may be responsible for the gingival enlargement. Additional testing and analysis, as described in this case, may be necessary.