Summary about Disease
Gingival fibromatosis (GF), also known as hereditary gingival fibromatosis (HGF) or gingival hyperplasia, is a rare oral condition characterized by slow, progressive, benign, non-neoplastic, and often generalized enlargement of the gingiva. The overgrowth is due to an increase in the fibrous connective tissue component of the gingiva. This can lead to cosmetic problems, difficulties in chewing and speaking, and periodontal complications. GF can occur as an isolated condition or as part of a syndrome.
Symptoms
Slow, progressive enlargement of the gingiva (gums).
Gums may appear firm, pink, and relatively normal in color, or may be more vascular and reddish.
Overgrowth can partially or completely cover the teeth.
Difficulty in chewing and speaking.
Poor aesthetics (appearance).
Retention of food debris, leading to increased risk of plaque accumulation, dental caries, and periodontal disease.
Delayed or ectopic tooth eruption in children.
In severe cases, lip protrusion or open bite.
Causes
Genetic Factors: Most cases are hereditary and caused by genetic mutations. Several genes have been implicated, including SOS1*, *EXT1*, *EXT2*, *RUNX2*, and *REST*.
Medications: Certain medications can induce gingival overgrowth, including:
Phenytoin (an anticonvulsant)
Cyclosporine (an immunosuppressant)
Calcium channel blockers (e.g., nifedipine, amlodipine)
Syndromes: GF can be a component of various genetic syndromes, such as:
Zimmermann-Laband syndrome
Murray-Puretic-Drescher syndrome
Ramon syndrome
Cross syndrome
Idiopathic: In some cases, the cause of GF is unknown.
Medicine Used
There is no specific medication to cure gingival fibromatosis. Treatment focuses on managing the overgrowth and preventing complications. Medications may be used to manage secondary infections or inflammation.
Antibiotics or Antimicrobials: Prescribed if there's a secondary bacterial or fungal infection.
Anti-inflammatory Medications: (e.g., Chlorhexidine mouthwash) used to reduce inflammation.
Alternative Medications: If the GF is medication-induced, switching to an alternative medication may be considered under medical supervision.
Is Communicable
Gingival fibromatosis is not communicable. It is primarily a genetic condition or caused by medications/underlying syndromes, not by infectious agents.
Precautions
Meticulous Oral Hygiene: Essential to prevent secondary infections and periodontal disease. This includes regular brushing, flossing, and use of antiseptic mouthwash.
Regular Dental Check-ups: Allows for early detection of complications and timely management of the overgrowth.
Avoidance of Irritants: Minimizing exposure to factors that can exacerbate gingival inflammation, such as smoking.
Genetic Counseling: If GF is suspected to be hereditary, genetic counseling can help assess the risk of transmission to future generations.
Inform Healthcare Providers: If the condition is medication-induced, inform all healthcare providers about all medications being taken, allowing for potential alternative prescriptions.
How long does an outbreak last?
Gingival fibromatosis is not an outbreak. It is a chronic condition. The gingival enlargement is typically slow and progressive, and it persists unless treated surgically or the causative medication is stopped (in drug-induced cases). The enlargement can continue for years if left unmanaged.
How is it diagnosed?
Clinical Examination: A dentist or periodontist will examine the gums, noting the extent and characteristics of the overgrowth.
Patient History: A detailed medical and family history is taken to identify potential genetic factors, medications, or underlying syndromes.
Radiographs: X-rays (e.g., periapical radiographs, panoramic radiographs) are used to assess the impact of the overgrowth on the underlying bone and to rule out other conditions.
Biopsy: A small sample of the affected gingival tissue is taken and examined under a microscope to confirm the diagnosis and rule out other conditions, such as gingival tumors.
Genetic Testing: If a hereditary cause is suspected, genetic testing may be performed to identify specific gene mutations.
Timeline of Symptoms
The onset and progression of symptoms vary depending on the cause and severity of the condition.
Early Childhood: In hereditary cases, gingival enlargement may be noticeable as early as infancy or early childhood, often coinciding with tooth eruption.
Adolescence/Adulthood: In medication-induced cases, the overgrowth typically develops within a few weeks to months of starting the medication. The rate of progression varies.
Progression: Regardless of the cause, the enlargement is generally slow and progressive over time. The rate of progression can vary between individuals.
Untreated: If left untreated, the overgrowth can eventually cover a significant portion of the teeth, causing functional and aesthetic problems.
Important Considerations
Differential Diagnosis: GF needs to be differentiated from other causes of gingival enlargement, such as inflammatory gingival hyperplasia, drug-induced gingival hyperplasia, leukemia-associated gingival enlargement, and gingival tumors.
Treatment Planning: Treatment planning should be individualized based on the cause, severity, and patient's needs.
Surgical Management: Surgical excision (gingivectomy) is the primary treatment for removing the excess gingival tissue. Various techniques can be used, including scalpel excision, electrosurgery, laser surgery, or periodontal flap surgery.
Recurrence: Recurrence is possible, especially in hereditary cases. Long-term follow-up and maintenance are essential.
Multidisciplinary Approach: Management may require a multidisciplinary approach involving a dentist, periodontist, oral surgeon, and potentially a geneticist.
Psychosocial Impact: The aesthetic concerns associated with GF can significantly impact a person's self-esteem and quality of life. Addressing these concerns is an important aspect of management.