Sharma B et al. Idiopathic Gingival Fibromatosis.

Case Report Idiopathic Gingival Fibromatosis: A Case Report Bharat Sharma, Archana Bhatia 1, Sandeep Kumar Bains 2, Nitin Gupta 3

Department of Oral Medicine and Radiology, Swami Devi Dyal Hospital and Dental College, Panchkula, 1Department of Periodontology and Oral Implantology Dasmesh Institute of Research and Dental Sciences, Faridkot, 2Department of Oral Medicine and Radiology, Dasmesh Institute of Research and Dental Sciences, 3Private practitioner, Moga, Punjab, India. ABSTRACT Hereditary gingival fibromatosis (HGF) is a rare Corresponding Author: condition that can occur as an isolated disease or as

part of a syndrome or chromosomal abnormality. In Dr. Sandeep Kumar Bains severe cases, the gingival enlargement may cover the Department of Oral Medicine and crowns of teeth and cause severe functional and Radiology, esthetic concerns. Histological and cell culture Dasmesh Institute of Research and studies have uncovered some of the molecular and Dental Science, Faridkot (Punjab). cellular changes associated with HGF. However, the E mail: [email protected] pathogenesis of the disease is still largely unknown. In this article, we report an unusual case of a non- syndromic, gingival fibromatosis associated with Received: 20-07-2013 generalized aggressive periodontitis in 25 years old Revised: 18-08-2013 male patient reported to the department of Accepted: 27-08-2013 Periodontics. Keywords: Hereditary gingival fibromatosis, gingival enlargement, Aggressive periodontitis

This article may be cited as: Sharma B, Bhatia A, Bains SK, Gupta N. Idiopathic Gingival Fibromatosis: A case report. J Adv Med Dent Scie 2013;1(2):147-150.

Introduction Hereditary gingival fibromatosis is a slowly Case Report progressive benign enlargement that affects A 25-year-old man reported to the outpatient the marginal gingiva, attached gingiva and department of Periodontics, Dasmesh interdental papilla 1. This condition is usually Institute of Research and dental sciences, part of a syndrome or, rarely, an isolated Faridkot (Punjab) with complaining of pain disorder. The gingival tissues are usually and swelling in the gums and an inability to pink and non-hemorrhagic, and have a firm, chew food. Patient’s history revealed that fibrotic consistency 2, .3,4 Aggressive the enlargement of the gums was present periodontitis comprises another group of since 10 years, and had gradually increased genetically inherited diseases that represent to the present size. It was associated with a severe and rapidly progressive form of bleeding gums and difficulty in brushing his periodontitis. Aggressive forms of teeth, speaking and eating from past two periodontitis are currently considered to be years. He had stopped brushing his teeth multifactorial diseases that develop as a since two months. result of complex interactions between General physical examination revealed no specific host genes and the environment.5 systemic abnormalities. Patient appeared to

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Sharma B et al. Idiopathic Gingival Fibromatosis. be physically, medically and mentally Full-mouth periodontal charting, including healthy. Two of his siblings and parents assessment of probing depth and clinical were examined, but there was no similar attachment level, revealed deep pockets enlargement. Family history was void of any throughout the mouth and scanty plaque and genetic disorders. There was no history of calculus deposits. Examination revealed drug intake. Personal history was non- generalized diffuse gingival enlargement significant. It was the patient’s first dental extending till the middle thirds of the visit. Gingival examination revealed clinical crowns and the degree of gingival moderate-to-severe gingival overgrowth of a enlargement was scored as Grade III firm, dense and fibrotic consistency that (Bokenkamp et al 1994) 4 (Figure 1-3). involved both the maxillary and mandibular arches. Halitosis was present due the poor oral hygiene.

Figure 2 : Gingival enlargement on palatal

surface of gingiva on maxillary arch.

Figure 1 : Intraoral photograph showing

generalized gingival enlargement (Frontal view).

Figure 3 : Gingival enlargement on palatal Figure 4: Panoramic radiograph of the surface of gingiva on mandibular arch. maxillary and mandibular arches showing severe generalized alveolar bone loss.

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Sharma B et al. Idiopathic Gingival Fibromatosis.

The radiographic findings, which materiaalba and plaque, which further corroborated those of the clinical complicates the existing hyperplastic tissue. examination, revealed severe generalized Maintenance of good oral hygiene is very alveolar bone loss (Figure 4). The peripheral important 6. Gingival fibromatosis can occur blood results were normal and correlated as an isolated condition or be associated with an absence of any history of systemic with other diseases and syndromes and the disease. The case was diagnosed as gingival involvement can be generalized or localized. fibromatosis with aggressive periodontitis The different forms can be classified as: 7 based on the findings of clinical and 1. Isolated HGF (generalized or localized); radiographic examination. A treatment plan 2. Isolated IGF (generalized or localized); was devised for the patient, which included 3. GF with hypertrichosis; complete scaling and root planning followed 4. GF with hypertrichosis and mental by full-mouth internal beveled retardation and/or epilepsy; gingivectomy. The patient initially 5. GF with mental retardation and/or underwent phase I periodontal therapy that epilepsy; and comprised scaling and root planing, oral 6. GF associated with other diseases as part hygiene instructions and adjunctive of a syndrome administration of systemic doxycycline (100 mg twice a day, on the first day, followed by The present case has to be differentiated 100 mg once a day for 14 days ). However from the following disorders like Neoplastic the surgical excision could not be performed gingival enlargement, drug induced gingival as the patient did not report for surgery, enlargement such as phenytoin, inspite of repeated motivation. cyclosporine, or calcium channel blockers, gingival enlargement due to nutritional Discussion deficiency, gingival enlargement associated The clinical expression of gingival with certain syndromes, gingival fibromatosis is highly heterogeneous. enlargement due to systemic diseases and Gingival enlargement may be generalized or conditions, allergies (plasma cell localized to a specific area, typically the gingivitis).However the clinical and maxillary tuberosities and the labial gingiva systemic examination ruled out the around the lower molars. The constant diagnosis of Neoplastic enlargement. increase in the tissue mass can result in Gingival enlargement occurs in some delayed eruption and displacement of teeth, patients taking certain drugs, such as arch deformity, spacing, and migration of phenytoin, cyclosporine and nifedipine. teeth.The condition is not painful until the However this patient had not taken any of tissue enlarges to partially cover the occlusal these drugs. The extensive enlargement surface of the molars and become suggested that the patient may have been traumatized during mastication, which was suffering from syndromes associated observed in the present case. Due to massive idiopathic gingival fibromatosisie; Murray- gingival enlargement, an affected child Puretic-Drescher syndrome, Rutherford usually develops abnormal swallowing syndrome, Laband syndrome, Cross pattern and experiences difficulty in speech syndrome or Cowden syndrome or others. and mastication. Along with these features, However general physical examination there may be some interference with the oral revealed no such syndromic associations. hygiene measures and normal mastication. Aggressive periodontitis is typically All these will favor accumulation of characterized by familial aggregation

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Sharma B et al. Idiopathic Gingival Fibromatosis. because of evidence of genetic References predisposition that was derived from 1.Coletta RD, Graner E. Hereditary gingival segregation analysis of affected families. 21 fibromatosis: A systematic review. J Mendelianinheritance occurs, and autosomal Periodontol 2006; 77: 753-764. (dominant and recessive) transmission and 2.Wynne SE, Aldred MJ, Bartold PM. X-linked transmission have been proposed. Hereditary gingival fibromatosis with Our patient had a diagnosis of generalized hearing loss and supernumerary teeth–a aggressive periodontitis with idiopathic new syndrome. J Periodontol 1995; 66:75- gingival fibromatosis, based on his clinical 79. findings and no history of familial 3.RashiChaturvedi.Idiopathic gingival aggregation. fibromatosis associated with generalized A case of hereditary gingival fibromatosis aggressive periodontitis:a case report. associated with generalized aggressive JADC; 2009:75:291-295. periodontitis reported earlier indicated the 4.Newmen Carranza. Textbook on clinical possible emergence of a new syndrome, but Periodontology.10 th edition no definite genetic linkage could be 5.Meng H, Xu L, Li Q, Han J, Zhao Y. established. However, due the rare Determinants of host susceptibility in observation of these lesions concurrently, it aggressive periodontitis. Periodontol 2007; is of interest both to clinician and basic 43:133–59. scientists to study such cases in further 6.Arvind K S,H J Shah, Patil A V.Idiopathic detail. gingival enlargement and its management- a case report. J Int Soc Periodontol 2010;14:263-265. 7.Pappachan B, Narayan JV, Nayak A. Idiopathic gingival fibromatosis—a neglected case. Indian J Radiol Imaging Source of support: Nil 2002;12:335-8. Conflict of interest: None declared

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